Provider Demographics
NPI:1447204821
Name:MARSHALL, STUART C JR (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:C
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STUART
Other - Middle Name:C
Other - Last Name:MARSHALL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 100253
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0253
Mailing Address - Country:US
Mailing Address - Phone:801-568-5972
Mailing Address - Fax:844-249-1746
Practice Address - Street 1:96 E KIMBALLS LN STE 207
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5025
Practice Address - Country:US
Practice Address - Phone:801-576-2300
Practice Address - Fax:844-249-1746
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5846455-1205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1265638357Medicaid
UTI38269Medicare UPIN
UT000059631Medicare PIN