1538101605 NPI number — MARSHALL B ROBERT MD

Table of content: MARSHALL B ROBERT MD (NPI 1538101605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538101605 NPI number — MARSHALL B ROBERT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERT
Provider First Name:
MARSHALL
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538101605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 E 7TH ST STE 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78701-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
737-707-3909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 S. HAMPTON RD.
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-501-9205
Provider Business Practice Location Address Fax Number:
469-629-1179
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036101648 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: N5364 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 296017103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08526614 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036101648 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080156896 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 343059 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9150613 . This is a "UNICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 296017101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060286 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 296017102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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