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1982608873

NPI Code Detail

MEDICARE: DR. JACK E MARSHALL MD

MEDICARE: DR. JACK E MARSHALL MD

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	207L00000X	Anesthesiology Physician	15252	OK
2	208VP0014X	Interventional Pain Medicine Physician	15252	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050058014	OTHER	OK	OLD MEDICARE RR
3	P00445607	OTHER	OK	MEDICARE RR

Other Identifiers

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

General Provider Information

NPI Number	:	1982608873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK E MARSHALL MD

Provider Business Mailing Address
First Line	:	PO BOX 269031
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-9031
Country	:	US
Telephone Number	:	405-286-9820
Fax Number	:	405-286-9813

Provider Business Practice Location Address
First Line	:	14100 PARKWAY COMMONS DR STE 102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-6036
Country	:	US
Telephone Number	:	406-286-9820
Fax Number	:	405-286-9813

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/20/2020

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Directions to “ DR. JACK E MARSHALL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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