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 |
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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 |
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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 |
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Provider Enumeration Date | 05/23/2007 |
Last Update Date | 12/10/2010 |
Medicare PECOS PAC ID | 4486681624 |
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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 |
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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 - Lakeside Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 10039 Vine St, Lakeside, CA 92040 Phone: 619-390-9975 Fax: 619-390-9872 |