Marshall, Jacob C.

Marshall, Jacob C. is an sole proprietor health care provider with primary practice located at 103 N Oak St , O Fallon IL 62269-1165. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Marshall, Jacob C. can be contacted via phone (888) 577-6337.

Contact Information

Primary practice address
103 N Oak St O Fallon IL 62269-1165
Phone: (888) 577-6337
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036102192 Illinois
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-102192 Illinois

Profile Details

NPI number 1922081249
LBN Legal business name Marshall, Jacob C.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 21st, 2005
Last updated Jul 12th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1922081249 NPPES
Illinois MEDICAID 036102192
Illinois MEDICAID 036102192 -8
Illinois MEDICAID 036102192-9
Illinois MEDICAID 1922081249
Illinois Other 08232204

Popular Providers