Provider Demographics
NPI:1700882545
Name:MARCUS, JEFFREY (MD, MPH, PA)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD, MPH, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 W PALMETTO PARK RD
Mailing Address - Street 2:STE 108A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3455
Mailing Address - Country:US
Mailing Address - Phone:561-368-4115
Mailing Address - Fax:561-368-0215
Practice Address - Street 1:7301 W PALMETTO PARK RD
Practice Address - Street 2:STE 108A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3455
Practice Address - Country:US
Practice Address - Phone:561-368-4115
Practice Address - Fax:561-368-0215
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2009-12-27
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
FLME0066595207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26789Medicare ID - Type Unspecified
FLG04603Medicare UPIN