Provider Demographics
NPI:1497939573
Name:MARSHALL, DAVID RODNEY (CPED)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RODNEY
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 STATE ROAD 13 NORTH
Mailing Address - Street 2:#100
Mailing Address - City:FRUIT COVE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3175
Mailing Address - Country:US
Mailing Address - Phone:904-230-8229
Mailing Address - Fax:904-230-8219
Practice Address - Street 1:585 STATE ROAD 13
Practice Address - Street 2:SUITE 100
Practice Address - City:FRUIT COVE
Practice Address - State:FL
Practice Address - Zip Code:32259-3175
Practice Address - Country:US
Practice Address - Phone:904-230-8229
Practice Address - Fax:904-230-8219
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
FLPED151335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6053350001Medicare NSC