Provider Demographics
NPI:1932245586
Name:BOOK, MARSHALL KELLER (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:KELLER
Last Name:BOOK
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 1:4224 HOUMA BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006
Mailing Address - Country:US
Mailing Address - Phone:504-456-8181
Mailing Address - Fax:504-456-8183
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-456-8181
Practice Address - Fax:504-456-8183
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011005207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1116009Medicaid
LA50636Medicare PIN
B62528Medicare UPIN