1861427601 NPI number — MR. MARSHALL ALAN FISCUS PHYSICIAN ASSISTANT

Table of content: MR. MARSHALL ALAN FISCUS PHYSICIAN ASSISTANT (NPI 1861427601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861427601 NPI number — MR. MARSHALL ALAN FISCUS PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISCUS
Provider First Name:
MARSHALL
Provider Middle Name:
ALAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
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:
1861427601
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HQ AETC A3N
Provider Second Line Business Mailing Address:
73 MAIN CIRCLE BLD 661
Provider Business Mailing Address City Name:
JBSA RANDOLPH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78150-4549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-652-7379
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 3RD ST W # BULD1040
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JBSA RANDOLPH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78150-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-652-7379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2006

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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