Provider Demographics
NPI:1245694231
Name:MARSHALL, DIAHANN (MD)
Entity type:Individual
Prefix:
First Name:DIAHANN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
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:PO BOX 735328
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-5328
Mailing Address - Country:US
Mailing Address - Phone:318-441-1041
Mailing Address - Fax:318-441-1050
Practice Address - Street 1:301 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8411
Practice Address - Country:US
Practice Address - Phone:318-441-1041
Practice Address - Fax:318-441-1050
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2838207Q00000X
390200000X
LA333177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program