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General NPI Number Information
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NPI Number | 1407855505
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Entity Type | Individual
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Provider Name | JASON JON MARSHALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 5147 N 9TH AVE SUITE 322
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City | PENSACOLA
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State | FL
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Zip | 32504-8710
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Country | US
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Telephone | 850-474-9995
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Fax | 850-477-6021
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Provider Business Mailing Address
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Address Line | 8333 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32514-6050
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Country | US
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Telephone | 850-474-8300
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Fax | 850-474-8654
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME86950
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License Number State | FL
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