Provider Demographics
NPI:1033263009
Name:MARSHALL, JOHN R (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 N COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5545
Mailing Address - Country:US
Mailing Address - Phone:817-860-6067
Mailing Address - Fax:817-860-6016
Practice Address - Street 1:1107 N COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5545
Practice Address - Country:US
Practice Address - Phone:817-860-6067
Practice Address - Fax:817-860-6016
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG53332084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000FS95Medicaid
TXD97515Medicare UPIN
TX00FS95Medicare ID - Type Unspecified