Provider Demographics
NPI:1851322291
Name:WILLETT, MARCUS STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:STEPHEN
Last Name:WILLETT
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 MICCOSUKEE ROAD
Mailing Address - Street 2:BIXLER EMERGENCY CENTER
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-431-0756
Mailing Address - Fax:850-431-0779
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:BIXLER EMERGENCY CENTER
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-0756
Practice Address - Fax:850-431-0779
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 87034207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29189OtherBCBS NUMBER
FL266703700Medicaid
FL29189OtherBCBS NUMBER
FL266703700Medicaid