Provider Demographics
NPI:1942296207
Name:MARSHALL, GARRETT LAIN (MD)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:LAIN
Last Name:MARSHALL
Suffix:
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 1:634 MAIN ST SUITE 4A
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501
Mailing Address - Country:US
Mailing Address - Phone:970-250-2878
Mailing Address - Fax:503-338-4031
Practice Address - Street 1:634 MAIN ST SUITE 4A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:OR
Practice Address - Zip Code:81501
Practice Address - Country:US
Practice Address - Phone:970-250-2878
Practice Address - Fax:503-338-4031
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2017-11-01
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
CO40579208100000X, 208100000X
CODR.0040579208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02922835Medicaid
CO02922835Medicaid
COH63039Medicare UPIN
ORR149264OtherMEDICARE PTAN