Provider Demographics
NPI:1962422543
Name:MARSHALL, KENT G (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:G
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 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:700 W 800 N STE 400
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-6305
Practice Address - Country:US
Practice Address - Phone:801-221-8811
Practice Address - Fax:801-221-8805
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183738-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT351047OtherDMBA
UT73466OtherPEHP
UT04-00986OtherUNITED HEALTHCARE
UT870281028000Medicaid
UT870281028MA6OtherEMIA
UTP00048651OtherPALMETTO
UTQM0000068055OtherALTIUS
UT107006950102OtherIHC
UT870281028000Medicaid