Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 18730 | MA |
NPI | 1154331395 |
---|---|
Provider Name | John A Marshall |
First Address | Fall River, MA 02720 |
Second Address | Fall River, MA 02720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 05/12/2012 |