Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 20A6309 | CA |
Y | 207RG0100X | Gastroenterologist | 20A6309 | CA |
NPI | 1467468090 |
---|---|
Provider Name | Jon Kevin Marsh |
First Address | Yuba City, CA 95991-4152 |
Second Address | Yuba City, CA 95991-4152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 16/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F34139 | (02) | CA |