Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 036061670 | IL |
NPI | 1174564116 |
---|---|
Provider Name | Robert De Wilton Marsh |
First Address | Evanston, IL 60201-1718 |
Second Address | Evanston, IL 60201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 12/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D82315 | (02) |