MEDICARE: DR. MICHAEL D. MARSH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	K2068	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K2068	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1003878646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D. MARSH M.D.

Provider Business Mailing Address
First Line	:	1929 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4703
Country	:	US
Telephone Number	:	817-596-3531
Fax Number	:	817-596-8822

Provider Business Practice Location Address
First Line	:	1929 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4703
Country	:	US
Telephone Number	:	817-596-3531
Fax Number	:	817-596-8822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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