Basic Information
| Provider Information | |||||||||
| NPI: | 1750370946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCUS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6058 NW 71ST TER | ||||||||
| Address2: | |||||||||
| City: | PARKLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330671208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548737330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19615 S STATE ROAD 7 | ||||||||
| Address2: | SUITE 32 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614777700 | ||||||||
| FaxNumber: | 5614777707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME44011 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 068639500 | 05 | FL | MEDICAID |