Provider Demographics
NPI:1568701332
Name:JACK E. MARSHALL MD LLC
Entity Type:Organization
Organization Name:JACK E. MARSHALL MD LLC
Other - Org Name:OSH PAIN MANAGEMENT ASSOCIATES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-605-6141
Mailing Address - Street 1:14100 PARKWAY COMMONS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-6104
Mailing Address - Country:US
Mailing Address - Phone:405-749-2765
Mailing Address - Fax:
Practice Address - Street 1:14100 PARKWAY COMMONS DR STE 201
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6104
Practice Address - Country:US
Practice Address - Phone:405-749-2765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15252208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty