Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01069458A | IN |
N | 208600000X | Surgeon | 01069458A | IN |
Y | 2086S0129X | Vascular Surgeon | 01069458A | IN |
NPI | 1114051612 |
---|---|
Provider Name | Brent David Marsden |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-2193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 04/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000714214 | ANTHEM BCBS (01) | IN |
201022140 | (05) | IN |