Provider Demographics
NPI:1689408205
Name:MARSHALL, LA'RON F
Entity type:Individual
Prefix:
First Name:LA'RON
Middle Name:F
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16757 E NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74116-4440
Mailing Address - Country:US
Mailing Address - Phone:918-720-9654
Mailing Address - Fax:
Practice Address - Street 1:16757 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-4440
Practice Address - Country:US
Practice Address - Phone:918-720-9654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist