| Larry J Marshall Md A Professional Corporation | |
|
12517 Lakeshore Dr Lakeside CA 92040-3103 | |
| (619) 443-3843 | |
| (619) 390-1810 |
| Full Name | Larry J Marshall Md A Professional Corporation |
|---|---|
| Speciality | General Practice |
| Location | 12517 Lakeshore Dr, Lakeside, California |
| Authorized Official Name and Position | Larry J Marshall (PRESIDENT) |
| Authorized Official Contact | 6194433843 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Larry J Marshall Md A Professional Corporation 12517 Lakeshore Dr Lakeside CA 92040-3103 Ph: (619) 443-3843 | Larry J Marshall Md A Professional Corporation 12517 Lakeshore Dr Lakeside CA 92040-3103 Ph: (619) 443-3843 |
| NPI Number | 1689884942 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 12/10/2010 |
| Medicare PECOS PAC ID | 4486681624 |
|---|---|
| Medicare Enrollment ID | O20050720000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689884942 | NPI | - | NPPES |
| 00A523440 | Other | CA | BLUE CROSS BLUE SHIELD |
| GR0081780 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A52344 (California) | Primary |
| Provider Name | Larry Marshall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114018132 PECOS PAC ID: 2860420486 Enrollment ID: I20110504000301 |
Rehabilitation Physical Therapy Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11534 Valle Vista Rd, Lakeside, CA 92040 Phone: 619-443-5116 Fax: 619-443-5347 | |
Neighborhood Healthcare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10039 Vine St, Lakeside, CA 92040 Phone: 619-390-9975 Fax: 619-390-9872 |