Provider Demographics
NPI:1053394544
Name:MARSHALL, DEBRA LYNN (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARSHALL
Other - Last Name:GOSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:825 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1743
Practice Address - Country:US
Practice Address - Phone:502-540-7200
Practice Address - Fax:502-540-7207
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32280207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2851803000OtherPAD - NCMA
KY64322803Medicaid
085492OtherSIHO - NCMA
50015283OtherPASSPORT - NCMA
KYP00410727OtherRAILROAD MEDICARE
KY000000514956OtherANTHEM - NCMA
50015283OtherPASSPORT - NCMA
KYP00410727OtherRAILROAD MEDICARE