Provider Demographics
NPI:1043301906
Name:MARSHALL, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N ROAD 38
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3141
Mailing Address - Country:US
Mailing Address - Phone:509-545-4466
Mailing Address - Fax:
Practice Address - Street 1:925 STEVENS DR
Practice Address - Street 2:SUITE 3-C
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3523
Practice Address - Country:US
Practice Address - Phone:509-946-0400
Practice Address - Fax:509-946-1685
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030900207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB26372Medicare PIN
WAB54843Medicare UPIN