Individual
DR. JACOB C. MARSHALL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
103 N OAK ST, O FALLON, IL 62269-1165
(888) 577-6337
Mailing address
2200 BOWLER RD, COLLINSVILLE, IL 62234-7012
(618) 977-9607
(618) 624-9302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-102192
IL
207Q00000X
Family Medicine Physician
Primary
036102192
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036102192
—
IL
05
—
036102192 -8
—
IL
05
—
036102192-9
—
IL
01
—
08232204
BLUE CROSS BLUE SHIELD
IL
05
—
1922081249
—
MO
Enumeration date
11/21/2005
Last updated
07/12/2010
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