Provider Demographics
NPI:1861427601
Name:FISCUS, MARSHALL ALAN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:ALAN
Last Name:FISCUS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HQ AETC A3N
Mailing Address - Street 2:73 MAIN CIRCLE BLD 661
Mailing Address - City:JBSA RANDOLPH
Mailing Address - State:TX
Mailing Address - Zip Code:78150-4549
Mailing Address - Country:US
Mailing Address - Phone:210-652-7379
Mailing Address - Fax:
Practice Address - Street 1:221 3RD ST W # BULD1040
Practice Address - Street 2:
Practice Address - City:JBSA RANDOLPH
Practice Address - State:TX
Practice Address - Zip Code:78150-4800
Practice Address - Country:US
Practice Address - Phone:210-652-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical