Provider Demographics
NPI:1295898724
Name:MARSHALL, NYRON T (MD)
Entity type:Individual
Prefix:DR
First Name:NYRON
Middle Name:T
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 1:4500 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2515
Mailing Address - Country:US
Mailing Address - Phone:228-575-2176
Mailing Address - Fax:228-575-2177
Practice Address - Street 1:12261 HIGHWAY 49
Practice Address - Street 2:SUITE 11
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2975
Practice Address - Country:US
Practice Address - Phone:228-575-2176
Practice Address - Fax:228-575-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0119981Medicaid
4946752OtherCIGNA ID
MSF83893Medicare UPIN
110001048Medicare ID - Type UnspecifiedPROVIDER NUMBER