Provider Demographics
NPI:1417213521
Name:MARSHALL, CARL BYRON (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:BYRON
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25959 130TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7927
Mailing Address - Country:US
Mailing Address - Phone:206-841-2924
Mailing Address - Fax:
Practice Address - Street 1:25959 130TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7927
Practice Address - Country:US
Practice Address - Phone:206-841-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2431792363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical