Provider Demographics
NPI:1609979228
Name:MARSHALL, JAMES CLIFFORD (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLIFFORD
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4577
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33775-4577
Mailing Address - Country:US
Mailing Address - Phone:727-585-3610
Mailing Address - Fax:727-585-4405
Practice Address - Street 1:12600 SEMINOLE BLVD
Practice Address - Street 2:#A-3
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-2201
Practice Address - Country:US
Practice Address - Phone:727-585-3610
Practice Address - Fax:727-585-4405
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73941207RC0000X
FLOS6394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371465900Medicaid
FLE65163Medicare UPIN
80720Medicare PIN