Provider Demographics
NPI:1043283898
Name:MAYER, MARCUS C (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:C
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NW 13TH STREET
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-338-3267
Mailing Address - Fax:561-391-4420
Practice Address - Street 1:1800 W WOOL BRIGHT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-737-8584
Practice Address - Fax:702-732-1036
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10450207Y00000X
FLME110071207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002303Medicaid
V37810Medicare PIN
VWJBGT01Medicare ID - Type Unspecified
NV002002303Medicaid