Individual
DEMETRI W MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2045 HIGHWAY 61 NORTH, PORT GIBSON, MS 39150-4262
(601) 437-3050
(601) 437-3051
Mailing address
P. O. BOX 741, PORT GIBSON, MS 39150-4262
(601) 437-3050
(601) 437-3051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10558
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017759
—
MS
Enumeration date
09/13/2006
Last updated
07/08/2007
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