Provider Demographics
NPI:1093722548
Name:MARSH, NAOMI S (DPM)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:S
Last Name:MARSH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 272634
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-2634
Mailing Address - Country:US
Mailing Address - Phone:813-960-2888
Mailing Address - Fax:813-925-1435
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD
Practice Address - Street 2:STE 206
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1356
Practice Address - Country:US
Practice Address - Phone:813-960-2888
Practice Address - Fax:813-925-1435
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO1807213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029639200Medicaid
EVERCAREOther2780722
FL480034119OtherRAILROAD MEDICARE
FL87938OtherBCBS
T88577Medicare UPIN
FL87938Medicare ID - Type UnspecifiedMEDICARE