Provider Demographics
NPI:1952648180
Name:MARSHALL, JOHN FRANKLYN (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANKLYN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:480 OSBORNE ROAD NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432
Mailing Address - Country:US
Mailing Address - Phone:763-785-4500
Mailing Address - Fax:763-785-3314
Practice Address - Street 1:480 OSBORNE ROAD NE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-785-4500
Practice Address - Fax:763-785-3314
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN18203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN824263100Medicaid
MNA95085Medicare UPIN
MN824263100Medicaid