Provider Demographics
NPI:1083743165
Name:JAMES C. MARSHALL, D.O.,F.A.C.C., P.A.
Entity Type:Organization
Organization Name:JAMES C. MARSHALL, D.O.,F.A.C.C., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-585-3610
Mailing Address - Street 1:PO BOX 4577
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-4577
Mailing Address - Country:US
Mailing Address - Phone:727-585-3610
Mailing Address - Fax:727-585-4405
Practice Address - Street 1:12600 SEMINOLE BLVD
Practice Address - Street 2:SUITE A-3
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2201
Practice Address - Country:US
Practice Address - Phone:727-585-3610
Practice Address - Fax:727-585-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6394207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371465900Medicaid
FLE65163Medicare UPIN
FL371465900Medicaid