Provider Demographics
NPI:1275692055
Name:ALEXANDER, MARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95201-0779
Mailing Address - Country:US
Mailing Address - Phone:209-373-2800
Mailing Address - Fax:209-373-2873
Practice Address - Street 1:600 NUT TREE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4669
Practice Address - Country:US
Practice Address - Phone:707-359-1800
Practice Address - Fax:707-359-1837
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50849Medicare ID - Type Unspecified