Provider Demographics
NPI:1356317051
Name:R LARRY MARSHALL MD PA
Entity Type:Organization
Organization Name:R LARRY MARSHALL MD PA
Other - Org Name:ROBERT LARRY MARSHALL
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-332-9688
Mailing Address - Street 1:1650 W ROSDALE
Mailing Address - Street 2:STE 302
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104
Mailing Address - Country:US
Mailing Address - Phone:817-332-9688
Mailing Address - Fax:
Practice Address - Street 1:1650 W ROSDALE
Practice Address - Street 2:STE 302
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-332-9688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9846207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00782TOtherMEDICARE GRP NO
E09222Medicare UPIN
TX8583B7Medicare ID - Type Unspecified