Provider Demographics
NPI:1679560411
Name:IRBY, MARSHALL SCOTT (MD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:SCOTT
Last Name:IRBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 ARMAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3752
Mailing Address - Country:US
Mailing Address - Phone:318-322-5864
Mailing Address - Fax:318-322-5992
Practice Address - Street 1:2810 ARMAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3752
Practice Address - Country:US
Practice Address - Phone:318-322-5864
Practice Address - Fax:318-322-5992
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08027R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1388068Medicaid
LA1388068Medicaid
LA5J510Medicare PIN