Provider Demographics
NPI:1912343419
Name:MARSHALL, ZACHARY WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:WADE
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 1:205 N OAK ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-7001
Mailing Address - Country:US
Mailing Address - Phone:682-593-9355
Mailing Address - Fax:608-713-8024
Practice Address - Street 1:205 N OAK ST UNIT B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-7001
Practice Address - Country:US
Practice Address - Phone:682-593-9355
Practice Address - Fax:608-713-8024
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-12
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10046672207R00000X
TXR5893207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine