Provider Demographics
NPI:1306911532
Name:MARSH, JULIET (MD)
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 PACIFIC AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7800
Mailing Address - Country:US
Mailing Address - Phone:253-471-3464
Mailing Address - Fax:
Practice Address - Street 1:3711 PACIFIC AVE STE 200
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7800
Practice Address - Country:US
Practice Address - Phone:253-471-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0186337Medicaid
MT144794Medicare UPIN
MT011000316Medicare PIN