Healthcare Provider Details

I. General information

NPI: 1508013301
Provider Name (Legal Business Name): MARC JEFFREY METH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 810
LOS ANGELES CA
90067-2011
US

IV. Provider business mailing address

2080 CENTURY PARK E STE 810
LOS ANGELES CA
90067-2011
US

V. Phone/Fax

Practice location:
  • Phone: 310-556-1377
  • Fax:
Mailing address:
  • Phone: 310-556-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number237973
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberA103999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: