Provider Demographics
NPI:1528461985
Name:MARSHALL, AUSTIN (PHD, PA-C)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20010 FLAX FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5379
Mailing Address - Country:US
Mailing Address - Phone:832-498-3137
Mailing Address - Fax:
Practice Address - Street 1:7101 W GRAND PKWY S STE 180
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8656
Practice Address - Country:US
Practice Address - Phone:832-498-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09399363A00000X
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA09399OtherTEXAS MEDICAL BOARD