Provider Demographics
NPI:1184869752
Name:TAMARA EVE MARCUS DPM
Entity type:Organization
Organization Name:TAMARA EVE MARCUS DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-243-3668
Mailing Address - Street 1:2641 BOX CANYON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0419
Mailing Address - Country:US
Mailing Address - Phone:702-243-3668
Mailing Address - Fax:702-243-3324
Practice Address - Street 1:2641 BOX CANYON DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0423
Practice Address - Country:US
Practice Address - Phone:702-243-3668
Practice Address - Fax:702-243-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8704213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0956110001Medicare NSC