MEDICARE: GLYN E.A. 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	208100000X	Physical Medicine & Rehabilitation Physician	MD00046815	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316031255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLYN E.A. MARSH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9787
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98909-0787
Country	:	US
Telephone Number	:	509-574-3300
Fax Number	:	509-225-3168

Provider Business Practice Location Address
First Line	:	301 W POPLAR ST STE 220
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2800
Country	:	US
Telephone Number	:	509-897-8959
Fax Number	:	509-897-5788

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/17/2021

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