Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 6293 | WA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | D9479 | OR |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 6293 | WA |
N | 204E00000X | Oral & Maxillofacial Surgeon | D9479 | OR |
NPI | 1134147309 |
---|---|
Provider Name | Ronald J Marsh |
First Address | Kennewick, WA 99336-7806 |
Second Address | Kennewick, WA 99336-7806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 25/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5014337 | (05) | WA |
U32796 | (02) | WA |