Provider Demographics
NPI:1467443812
Name:MARSH, RONALD GEORGE (LSA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:GEORGE
Last Name:MARSH
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 451774
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77245-1774
Mailing Address - Country:US
Mailing Address - Phone:713-806-4065
Mailing Address - Fax:281-489-4577
Practice Address - Street 1:4114 CANDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-5604
Practice Address - Country:US
Practice Address - Phone:713-618-1477
Practice Address - Fax:281-489-9839
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2014-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00216363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00216OtherSTATE LICENSE