Provider Demographics
NPI:1316031255
Name:MARSH, GLYN EA (MD)
Entity Type:Individual
Prefix:
First Name:GLYN
Middle Name:EA
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9787
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-0787
Mailing Address - Country:US
Mailing Address - Phone:509-574-3300
Mailing Address - Fax:509-225-3168
Practice Address - Street 1:301 W POPLAR ST STE 220
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2800
Practice Address - Country:US
Practice Address - Phone:509-897-8959
Practice Address - Fax:509-897-5788
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046815208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128648Medicaid
WA7128648Medicaid