Individual
GENA WILLARD MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9101 N CENTRAL EXPY STE 600, DALLAS, TX 75231-5956
(214) 818-0935
Mailing address
9101 NORTH CENTRAL EXPRESSWAY, SUITE 600, DALLAS, TX 75231
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03192
TX
363AM0700X
Medical Physician Assistant
PA03192
TX
363AS0400X
Surgical Physician Assistant
PA03192
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922095173
BLUE CROSS BLUE SHIELD
TX
05
—
206246501
—
TX
05
—
206246502
—
TX
05
—
206246503
—
TX
05
—
206246504
—
TX
01
—
8376ND
BLUE CROSS BLUE SHIELD
TX
01
—
864N28
BCBS
TX
01
—
8Y8690
BLUE CROSS BLUE SHIELD
TX
01
—
P00735961
RAILROAD MEDICARE
TX
01
—
P01107875
RR MEDICARE
TX
01
—
P01259383
MEDICARE RR
TX
Enumeration date
10/03/2005
Last updated
08/28/2017
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