Provider Demographics
NPI:1437191574
Name:MARSHALL, DOUGLAS WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WARREN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 CONCORD PLAZA DR
Mailing Address - Street 2:300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6905
Mailing Address - Country:US
Mailing Address - Phone:210-804-5480
Mailing Address - Fax:210-804-5419
Practice Address - Street 1:400 CONCORD PLAZA DR
Practice Address - Street 2:300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6905
Practice Address - Country:US
Practice Address - Phone:210-804-5480
Practice Address - Fax:210-804-5419
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG62092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1425172OtherCIGNA
TX8H3630OtherBCBS
TXP00067872OtherRAILROAD MEDICARE
TX4116848OtherAETNA
TX8H3630OtherBCBS
TX8A4375Medicare PIN