Provider Demographics
NPI:1629176128
Name:MARSHALL, JUNE GABRIELLE (MD)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:GABRIELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11307 FM 1960 RD W
Mailing Address - Street 2:STE 230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3687
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11307 FM 1960 RD W
Practice Address - Street 2:STE 230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3687
Practice Address - Country:US
Practice Address - Phone:910-676-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5961174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00F75TOtherMEDICARE ID
TX033218101Medicaid
LA1649341OtherLOUISIANA PROVIDER NUMBER
TX10019905OtherAMERIGROUP
LA1649341OtherLOUISIANA PROVIDER NUMBER