Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME0035510 | FL |
NPI | 1033114426 |
---|---|
Provider Name | Dr. William R Marshall |
First Address | Fort Walton Beach, FL 32547-6645 |
Second Address | Fort Walton Beach, FL 32547-6645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 12/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038689800 | (05) | FL |
406203902 | RAILROAD MEDICARE (01) | FL |
D62476 | (02) | FL |