Individual
DR. JACK E MARSHALL
Active
Individual
DR. JACK E MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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