Provider Demographics
NPI:1710208681
Name:MARSHALL, MICHAEL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:THOMAS
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 MERCY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-719-3210
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DRIVE UROLOGY DEPARTMENT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5191
Practice Address - Country:US
Practice Address - Phone:619-532-7200
Practice Address - Fax:619-532-7234
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266024208800000X
CAA117561208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty