Provider Demographics
NPI:1609267954
Name:JOHN S. MARSHBURN, M.D., INC
Entity Type:Organization
Organization Name:JOHN S. MARSHBURN, M.D., INC
Other - Org Name:JOHN S. MARSHBURN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARSHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-792-1199
Mailing Address - Street 1:1275 N ROSE DR
Mailing Address - Street 2:#112
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3941
Mailing Address - Country:US
Mailing Address - Phone:714-792-1199
Mailing Address - Fax:714-792-1196
Practice Address - Street 1:1275 N ROSE DR
Practice Address - Street 2:#112
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3941
Practice Address - Country:US
Practice Address - Phone:714-792-1199
Practice Address - Fax:714-792-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60789207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA60789Medicare UPIN