=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649468976
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DESERT MENS HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 08/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 E BUENA VISTA ST
-----------------------------------------------------
City | BARSTOW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92311-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-255-3265
-----------------------------------------------------
Fax | 760-256-2935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 E BUENA VISTA ST
-----------------------------------------------------
City | BARSTOW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92311-2806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-255-3265
-----------------------------------------------------
Fax | 760-256-2935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DR. DAVID W MARSH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 760-255-3265
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | A97473
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------