Provider Demographics
NPI:1154345445
Name:MARSHALL, STUART CHARLES (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:CHARLES
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 GIRARD AVE
Mailing Address - Street 2:204
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5138
Mailing Address - Country:US
Mailing Address - Phone:858-459-3710
Mailing Address - Fax:858-459-3706
Practice Address - Street 1:7300 GIRARD AVE
Practice Address - Street 2:204
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5138
Practice Address - Country:US
Practice Address - Phone:858-459-3710
Practice Address - Fax:858-459-3706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21075207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G210750Medicaid
CA00G210750Medicaid
CAG21075Medicare ID - Type Unspecified