Provider Demographics
NPI:1982718342
Name:MARCUS, BRADLEY ARTHUR (DO)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ARTHUR
Last Name:MARCUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2667 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-1435
Mailing Address - Country:US
Mailing Address - Phone:858-922-6674
Mailing Address - Fax:
Practice Address - Street 1:2667 GARDEN CT
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-1435
Practice Address - Country:US
Practice Address - Phone:858-922-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15864208100000X
CA20A9020208100000X
NV1915208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS15864OtherFLORIDA OSTEOPATHIC MEDICAL BOARD
NV1915OtherNV MEDICAL LICENSE
NVCS74338OtherNV PHARMACY