Provider Demographics
NPI:1467468090
Name:MARSH, JON KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:KEVIN
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 SHASTA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4152
Mailing Address - Country:US
Mailing Address - Phone:530-671-3671
Mailing Address - Fax:530-671-3980
Practice Address - Street 1:870 SHASTA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4152
Practice Address - Country:US
Practice Address - Phone:530-671-3671
Practice Address - Fax:530-671-3980
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6309170100000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF34139Medicare UPIN
CA020A63090Medicare ID - Type Unspecified