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General NPI Number Information
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NPI Number | 1457595001
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Entity Type | Individual
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Provider Name | MARK ABRAHAM MARSHALL
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Gender | Male
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 3300 DOUGLAS BLVD., SUITE 405 EMP
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City | ROSEVILL
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State | CA
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Zip | 95661
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Country | US
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Telephone | 330-493-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 120 WILD RIVER LN
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City | FOLSOM
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State | CA
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Zip | 95630-2023
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Country | US
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Telephone | 515-508-9223
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 20A 12191
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34. 010307
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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