Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2384 | MT |
NPI | 1063670032 |
---|---|
Provider Name | Robert Jay Marshall |
First Address | Great Falls, MT 59405-3013 |
Second Address | Great Falls, MT 59405-3013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 03/02/2010 |