1699786111 NPI number — J MARSHALL ANTHONY DO JD LTD

Table of content: (NPI 1699786111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699786111 NPI number — J MARSHALL ANTHONY DO JD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J MARSHALL ANTHONY DO JD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JAMES M ANTHONY DO
Provider Other Organization Name Type Code:
3
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:
1699786111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 E CHARLESTON BLVD
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89104-6665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 E CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89104-6665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-641-6008
Provider Business Practice Location Address Fax Number:
702-641-7085
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANTHONY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
702-641-6008

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  765 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2990011 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2990011 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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