Provider Demographics
NPI:1659458248
Name:DEBENEDICTIS, MARJORIE FRICKE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:FRICKE
Last Name:DEBENEDICTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:633 GOV CARLOS CAMACHO RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3300
Mailing Address - Country:US
Mailing Address - Phone:671-647-5829
Mailing Address - Fax:671-647-5830
Practice Address - Street 1:633 GOV CARLOS CAMACHO RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3300
Practice Address - Country:US
Practice Address - Phone:671-647-5829
Practice Address - Fax:671-647-5830
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GUM001334207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology