Provider Demographics
NPI:1972743904
Name:MARSHALL, EDWARD MORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MORRIS
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 1:3763 REGAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4802
Mailing Address - Country:US
Mailing Address - Phone:818-501-0573
Mailing Address - Fax:818-501-0396
Practice Address - Street 1:3763 REGAL VISTA DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4802
Practice Address - Country:US
Practice Address - Phone:818-501-0573
Practice Address - Fax:818-501-0396
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine