Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME20810 | FL |
NPI | 1427057397 |
---|---|
Provider Name | Dr. M Jeffrey Marcus |
First Address | Inverness, FL 34452-4623 |
Second Address | Inverness, FL 34452-4623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
057682400 | (05) | FL |
44142 | BLUE CROSS (01) | FL |
592023722 | TAX ID (01) | FL |
D67202 | (02) | FL |