MEDICARE: DR. JOHN ELLIS MARSHALL IV

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	213ES0103X	Foot & Ankle Surgery Podiatrist	692114	TX

General Provider Information

NPI Number	:	1518596048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ELLIS MARSHALL IV

Provider Business Mailing Address
First Line	:	P.O. BOX 675204
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75267-5204
Country	:	US
Telephone Number	:	512-255-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	7200 WYOMING SPRINGS DR STE 1150
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4310
Country	:	US
Telephone Number	:	512-255-0125
Fax Number	:

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

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	07/03/2024

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