Provider Demographics
NPI:1437116944
Name:STOCKTON, MARSHALL DAVID (MD, MPH)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:DAVID
Last Name:STOCKTON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HWY
Mailing Address - Street 2:U-67
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-305-9352
Mailing Address - Fax:865-305-9314
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:U-115
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9351
Practice Address - Fax:865-305-9314
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11393207Q00000X, 207QG0300X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100010692OtherPHP TENNCARE
TN3373352OtherUFP MEDICAID GRP
TNTN0188OtherJOHN DEERE
TN1689631137OtherGROUP NPI
TN6560974OtherCIGNA
TN3049798OtherBLUE CROSS/BLUE SHIELD
TN3185087Medicaid
TN3373352OtherUFP MEDICARE GRP
TN01-42505OtherUNITED HEALTH CARE
TN080089336OtherRAILROAD MEDICARE
TN3185089OtherAETNA
3185089Medicare ID - Type Unspecified
TN3185089OtherAETNA