Provider Demographics
NPI:1558642934
Name:MARCUS, GEORGE EDWARD III (PA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:MARCUS
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7465
Mailing Address - Country:US
Mailing Address - Phone:615-426-5760
Mailing Address - Fax:
Practice Address - Street 1:8764 ORTEGA PARK DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-4139
Practice Address - Country:US
Practice Address - Phone:850-407-3646
Practice Address - Fax:850-407-3648
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN390200000X
TN2007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program