Provider Demographics
NPI:1467102327
Name:MARSHALL, WILLIAM BERT JR (LAT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BERT
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CRESTWAY
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-1648
Mailing Address - Country:US
Mailing Address - Phone:830-743-6839
Mailing Address - Fax:
Practice Address - Street 1:110 CRESTWAY
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-1648
Practice Address - Country:US
Practice Address - Phone:830-743-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLAT1523207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine