Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 14840 | GA |
NPI | 1609959725 |
---|---|
Provider Name | Dr. Robert David Marcus |
First Address | Columbus, GA 31909-2088 |
Second Address | Columbus, GA 31909-2088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D40541 | (02) | GA |