Provider Demographics
NPI:1518137330
Name:DYKE, MARSHALL J
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:J
Last Name:DYKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 MANSIONS VIEW DR APT 702
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4343
Mailing Address - Country:US
Mailing Address - Phone:936-232-0440
Mailing Address - Fax:
Practice Address - Street 1:8333 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-6853
Practice Address - Country:US
Practice Address - Phone:713-776-9904
Practice Address - Fax:713-776-9946
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist