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General NPI Number Information
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NPI Number | 1740385103
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Entity Type | Individual
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Provider Name | DEMETRI W MARSHALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2045 HIGHWAY 61 NORTH
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City | PORT GIBSON
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State | MS
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Zip | 39150-4262
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Country | US
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Telephone | 601-437-3050
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Fax | 601-437-3051
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Provider Business Mailing Address
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Address Line | P. O. BOX 741
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City | PORT GIBSON
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State | MS
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Zip | 39150-4262
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Country | US
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Telephone | 601-437-3050
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Fax | 601-437-3051
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10558
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License Number State | MS
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