MEDICARE: MR. RONALD GEORGE MARSH L.S.A.

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	363AS0400X	Surgical Physician Assistant	SA00216	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA00216	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1467443812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD GEORGE MARSH L.S.A.

Provider Business Mailing Address
First Line	:	PO BOX 451774
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77245-1774
Country	:	US
Telephone Number	:	713-806-4065
Fax Number	:	281-489-4577

Provider Business Practice Location Address
First Line	:	4114 CANDLEWOOD LN
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-5604
Country	:	US
Telephone Number	:	713-618-1477
Fax Number	:	281-489-9839

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	04/28/2014

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