Provider Demographics
NPI:1750370946
Name:MARCUS, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 NW 71ST TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1208
Mailing Address - Country:US
Mailing Address - Phone:954-873-7330
Mailing Address - Fax:
Practice Address - Street 1:19615 S STATE ROAD 7
Practice Address - Street 2:SUITE 32
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498
Practice Address - Country:US
Practice Address - Phone:561-477-7700
Practice Address - Fax:561-477-7707
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068639500Medicaid