Provider Demographics
NPI:1841513371
Name:MARSTON SHAUN HOLT MD PA
Entity type:Organization
Organization Name:MARSTON SHAUN HOLT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSTON
Authorized Official - Middle Name:SHAUN
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-335-1111
Mailing Address - Street 1:1045 GEMINI ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2806
Mailing Address - Country:US
Mailing Address - Phone:281-335-1111
Mailing Address - Fax:281-286-3290
Practice Address - Street 1:1045 GEMINI ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2806
Practice Address - Country:US
Practice Address - Phone:281-335-1111
Practice Address - Fax:281-286-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH93619Medicare UPIN