# LARRY J MARSHALL MD A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689884942
- **Authorized official:** MR. LARRY J MARSHALL M.D. (PRESIDENT)
- **Authorized official phone:** (619) 443-3843

## Contact information

- **Practice address:** 12517 LAKESHORE DR, LAKESIDE, CA 92040-3103
- **Practice address phone:** (619) 443-3843
- **Practice address fax:** (619) 390-1810
- **Mailing address:** 12517 LAKESHORE DR, LAKESIDE, CA 92040-3103
- **Mailing address phone:** (619) 443-3843
- **Mailing address fax:** (619) 390-1810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A52344 | CA | Yes |

## Other

- **Enumeration date:** 05/23/2007
- **Last updated:** 12/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00A523440 | BLUE CROSS BLUE SHIELD | CA |
| 05 | — | GR0081780 | — | CA |