1154612034 NPI number — JUNE MARSHALL,M.D.,P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154612034 NPI number — JUNE MARSHALL,M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUNE MARSHALL,M.D.,P.A.
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:
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:
1154612034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7333 NORTH FWY
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77076-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-697-2897
Provider Business Mailing Address Fax Number:
713-490-7248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7333 NORTH FWY
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77076-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-697-2897
Provider Business Practice Location Address Fax Number:
713-490-7248
Provider Enumeration Date:
04/26/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MARSHALL
Authorized Official First Name:
JUNE
Authorized Official Middle Name:
GABRIELLE
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
713-697-2897

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G5961 , 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: 00F75T . This is a "MEDICARE ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1649341 . This is a "LOUISIANA PROVIDER NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 10019905 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 033218101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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