Provider Demographics
NPI:1023056595
Name:MARSHALL, JULIA (PAC)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650615
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0615
Mailing Address - Country:US
Mailing Address - Phone:972-566-7788
Mailing Address - Fax:972-566-8837
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE B332
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6822
Practice Address - Country:US
Practice Address - Phone:972-566-7788
Practice Address - Fax:972-566-8837
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6237Medicare UPIN
AR5J356P107Medicare UPIN