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General NPI Number Information
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NPI Number | 1568774628
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Entity Type | Individual
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Provider Name | JUSTIN MARSH MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 790 CONCOURSE PKWY S STE 200
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City | MAITLAND
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State | FL
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Zip | 32751-6114
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Country | US
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Telephone | 407-767-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 GILLHAM RD
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City | KANSAS CITY
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State | MO
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Zip | 64108-4619
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Country | US
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Telephone | 816-234-3000
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 04-38026
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 2015014708
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME143292
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License Number State | FL
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