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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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