Provider Demographics
NPI:1295863488
Name:MARSHALL, DANIEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
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 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4572
Mailing Address - Country:US
Mailing Address - Phone:901-323-1200
Mailing Address - Fax:901-452-6823
Practice Address - Street 1:515 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4572
Practice Address - Country:US
Practice Address - Phone:901-323-1200
Practice Address - Fax:901-452-6823
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009649208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0026833OtherBLUE BROSS
TN3181513Medicare ID - Type Unspecified
TN0026833OtherBLUE BROSS