Provider Demographics
NPI:1760676076
Name:MARSHALL B PACKARD, P.A.
Entity Type:Organization
Organization Name:MARSHALL B PACKARD, P.A.
Other - Org Name:MARSHALL B PACKARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-504-5601
Mailing Address - Street 1:1865 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:HEMPHILL
Mailing Address - State:TX
Mailing Address - Zip Code:75948-7201
Mailing Address - Country:US
Mailing Address - Phone:409-787-1945
Mailing Address - Fax:409-787-4593
Practice Address - Street 1:1865 WORTH ST
Practice Address - Street 2:
Practice Address - City:HEMPHILL
Practice Address - State:TX
Practice Address - Zip Code:75948-7201
Practice Address - Country:US
Practice Address - Phone:409-787-1945
Practice Address - Fax:409-787-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1419208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty