Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MT200843 | PA |
NPI | 1215299573 |
---|---|
Provider Name | Dr. Matthew D Marsh |
First Address | Spring Hill, FL 34609-8102 |
Second Address | Brooksville, FL 34613-6003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015409400 | (05) | FL |