Provider Demographics
NPI:1629263652
Name:MARSHALL GASTROENTEROLOGY, P.A.
Entity Type:Organization
Organization Name:MARSHALL GASTROENTEROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-927-6680
Mailing Address - Street 1:815 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5369
Mailing Address - Country:US
Mailing Address - Phone:903-927-6680
Mailing Address - Fax:903-927-6681
Practice Address - Street 1:815 S WASHINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5369
Practice Address - Country:US
Practice Address - Phone:903-927-6680
Practice Address - Fax:903-927-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5017207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00600RMedicare PIN
EO1376Medicare UPIN