Healthcare Provider Details

I. General information

NPI: 1689678583
Provider Name (Legal Business Name): BARRY MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N 92ND ST STE 201
SCOTTSDALE AZ
85258-4524
US

IV. Provider business mailing address

10210 N 92ND ST STE 201
SCOTTSDALE AZ
85258-4524
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-0388
  • Fax: 480-767-3846
Mailing address:
  • Phone: 480-551-0388
  • Fax: 480-767-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number11338
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: