Basic Information
| Provider Information | |||||||||
| NPI: | 1659357093 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ALEXANDER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 265 E ELMVIEW PL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782093807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038506363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3851 ROGER BROOKE DR MCHE QD(CREDS) | ||||||||
| Address2: | BROOKE ARMY MEDICAL CENTER | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 12/20/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 47130-020 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | 47130-020 | WI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
No ID Information.