Provider Demographics
NPI:1114327400
Name:MARSHALL, BYRON JR (PA-C)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-5562
Mailing Address - Country:US
Mailing Address - Phone:281-331-0082
Mailing Address - Fax:281-331-2624
Practice Address - Street 1:1100 SMITH DR
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5562
Practice Address - Country:US
Practice Address - Phone:281-331-0082
Practice Address - Fax:281-331-2624
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant