1922109354 NPI number — DR. PATRICK JAMES MARSH D.O.

Table of content: DR. PATRICK JAMES MARSH D.O. (NPI 1922109354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922109354 NPI number — DR. PATRICK JAMES MARSH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSH
Provider First Name:
PATRICK
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1922109354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7440 N ORACLE RD
Provider Second Line Business Mailing Address:
# 7
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85704-6385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-797-5603
Provider Business Mailing Address Fax Number:
520-638-5574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 W ORANGE GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85704-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-797-8555
Provider Business Practice Location Address Fax Number:
520-575-1566
Provider Enumeration Date:
09/26/2006

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:  2502 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29-10-0093 . This is a "STATE COMPENSATION FUND" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0221640 . This is a "BC/BS OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00216247 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2502 . This is a "ARIZONA STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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