Provider Demographics
NPI:1407855505
Name:MARSHALL, JASON JON (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JON
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 1:8333 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-474-8300
Mailing Address - Fax:850-474-8654
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8710
Practice Address - Country:US
Practice Address - Phone:850-474-9995
Practice Address - Fax:850-477-6021
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7494548OtherAETNA
AL009985135Medicaid
FL267619200Medicaid
2122379OtherFIRST HEALTH
FL71936OtherBCBS
AL59177073OtherBCBS
AL59177073OtherBCBS
2122379OtherFIRST HEALTH
H92037Medicare UPIN