Provider Demographics
NPI:1427079987
Name:MARSHALL, TIMOTHY M (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
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:PO BOX 43130
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3130
Mailing Address - Country:US
Mailing Address - Phone:520-722-3777
Mailing Address - Fax:520-296-6224
Practice Address - Street 1:5170 E GLENN ST
Practice Address - Street 2:BLDG 2, STE. 160
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1337
Practice Address - Country:US
Practice Address - Phone:520-298-7900
Practice Address - Fax:520-290-5083
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22934207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF99258Medicare UPIN
AZZ103259Medicare PIN