Provider Demographics
NPI:1861442998
Name:MARSHALL, TERROL DUANE (DPM)
Entity type:Individual
Prefix:DR
First Name:TERROL
Middle Name:DUANE
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 SW DORION AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2086
Mailing Address - Country:US
Mailing Address - Phone:541-276-2372
Mailing Address - Fax:541-276-2411
Practice Address - Street 1:714 SW DORION AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2086
Practice Address - Country:US
Practice Address - Phone:541-276-2372
Practice Address - Fax:541-276-2411
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00357213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00613653OtherRAILROAD MEDICARE
OR234444Medicaid
ORP00613653OtherRAILROAD MEDICARE
ORU86797Medicare UPIN