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Organization
LARRY J MARSHALL MD A PROFESSIONAL CORPORATION
Active
Organization
LARRY J MARSHALL MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY J MARSHALL M.D. (PRESIDENT)
(619) 443-3843
Entity
Organization
Contact information
Practice address
12517 LAKESHORE DR, LAKESIDE, CA 92040-3103
(619) 443-3843
(619) 390-1810
Mailing address
12517 LAKESHORE DR, LAKESIDE, CA 92040-3103
(619) 443-3843
(619) 390-1810
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A52344
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A523440
BLUE CROSS BLUE SHIELD
CA
05
—
GR0081780
—
CA
Enumeration date
05/23/2007
Last updated
12/10/2010
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