Provider Demographics
NPI:1780067066
Name:MONSON, MARSHALL (DPM)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:MONSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 FULTON AVE
Mailing Address - Street 2:APT 58
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7380
Mailing Address - Country:US
Mailing Address - Phone:307-259-9653
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5153
Practice Address - Country:US
Practice Address - Phone:307-259-9653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5447213ES0103X
NMT-1558213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery