Provider Demographics
NPI:1356335046
Name:MARSH, L. DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:L. DOUGLAS
Middle Name:
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L. DOUGLAS
Other - Middle Name:
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4421 NE ST JOHNS RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2573
Mailing Address - Country:US
Mailing Address - Phone:360-695-9922
Mailing Address - Fax:360-695-1310
Practice Address - Street 1:406 SE 131ST AVE
Practice Address - Street 2:SUITE A101
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-253-2822
Practice Address - Fax:360-253-8642
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31623208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8195190Medicaid
WAAB15203Medicare ID - Type Unspecified
WAGAB27757Medicare PIN
WA8195190Medicaid