Individual
DR. JACK E MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14100 PARKWAY COMMONS DR STE 102, OKLAHOMA CITY, OK 73134-6036
(406) 286-9820
(405) 286-9813
Mailing address
PO BOX 269031, OKLAHOMA CITY, OK 73126-9031
(405) 286-9820
(405) 286-9813
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
15252
OK
208VP0014X
Interventional Pain Medicine Physician
Primary
15252
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050058014
OLD MEDICARE RR
OK
05
—
100124480A
—
OK
01
—
P00445607
MEDICARE RR
OK
Enumeration date
06/08/2005
Last updated
02/20/2020
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