Individual
DR. MARSHAL T GWYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
401 ROGERS ST, PRINCETON, WV 24740-3636
(304) 487-9442
(330) 536-0069
Mailing address
PO BOX 365, PROSPERITY, WV 25909-0365
(304) 487-9442
(330) 542-9932
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0103301085
VA
213E00000X
Podiatrist
10436
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VVA226A
MEDICARE NUMBER
VA
Enumeration date
04/23/2010
Last updated
06/09/2020
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