Provider Demographics
NPI:1720031560
Name:MARSHALL, JOHN A II (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MARSHALL
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 W IH 10 STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1004
Mailing Address - Country:US
Mailing Address - Phone:210-877-0772
Mailing Address - Fax:
Practice Address - Street 1:12730 W IH 10 STE 306
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1004
Practice Address - Country:US
Practice Address - Phone:210-877-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034907803Medicaid
TXM52043Medicare UPIN
TX8A6497Medicare ID - Type Unspecified