Provider Demographics
NPI:1255300166
Name:MARSHALL, DENNIS JAMES (CPO)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JAMES
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3143
Mailing Address - Country:US
Mailing Address - Phone:907-374-3381
Mailing Address - Fax:907-374-3380
Practice Address - Street 1:13 TIMBERLAND DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3143
Practice Address - Country:US
Practice Address - Phone:907-374-3381
Practice Address - Fax:907-374-3380
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPO008731744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK7862526OtherAETNA, PROSTHTICS & ORTHO
AKPO8040Medicaid
AK202752400OtherOWCP PROSTHEICS/ORTHOTICS
AK3682150001Medicare NSC