Healthcare Provider Details

I. General information

NPI: 1528044195
Provider Name (Legal Business Name): JOEL DANIEL MARCUS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BMDA - BANNER UNIVERSITY MEDICAL CENTER 925 E. MCDOWELL RD
PHOENIX AZ
85006
US

IV. Provider business mailing address

BMDA - BANNER UNIVERSITY MEDICAL CENTER 925 E. MCDOWELL RD
PHOENIX AZ
85006
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-3700
  • Fax: 216-538-6271
Mailing address:
  • Phone: 602-521-3700
  • Fax: 702-944-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1180
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32143
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: