Provider Demographics
NPI:1427274026
Name:PETER H. MARSH, M.D., PA
Entity type:Organization
Organization Name:PETER H. MARSH, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HYATT
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-932-2142
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-5403
Mailing Address - Country:US
Mailing Address - Phone:972-932-2142
Mailing Address - Fax:972-962-5185
Practice Address - Street 1:874 ED HALL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1861
Practice Address - Country:US
Practice Address - Phone:972-932-2142
Practice Address - Fax:972-962-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1470207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD04991OtherPALMETTO GBA RAILROAD MEDICARE
TX0017RZOtherBLUE CROSS BLUE SHIELD PROVIDER
TX2005100001Medicaid
TX0017RZOtherBLUE CROSS BLUE SHIELD PROVIDER
TX00Y972Medicare PIN