Provider Demographics
NPI:1053460220
Name:M JEFFREY MARCUS MD FACS PA
Entity Type:Organization
Organization Name:M JEFFREY MARCUS MD FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-726-3131
Mailing Address - Street 1:821 MEDICAL CT E
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4623
Mailing Address - Country:US
Mailing Address - Phone:352-726-3131
Mailing Address - Fax:352-726-7202
Practice Address - Street 1:821 MEDICAL CT E
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4623
Practice Address - Country:US
Practice Address - Phone:352-726-3131
Practice Address - Fax:888-491-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20810207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44142OtherBLUE CROSS
FLDG0919OtherRAILROAD MEDICARE
FL59200023722OtherTAX ID
FL276145900Medicaid