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General NPI Number Information
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NPI Number | 1861583486
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Entity Type | Individual
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Provider Name | DANIEL R MARSHALL DO
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 393 E 2ND N
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City | REXBURG
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State | ID
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Zip | 83440-1605
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Country | US
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Telephone | 208-359-4841
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Fax | 208-359-4842
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Provider Business Mailing Address
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Address Line | 393 E 2ND N
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City | REXBURG
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State | ID
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Zip | 83440-1605
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Country | US
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Telephone | 208-359-4841
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Fax | 208-359-4842
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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 | 2006018423
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | O-0508
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | O-0508
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License Number State | ID
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