Healthcare Provider Details

I. General information

NPI: 1912234121
Provider Name (Legal Business Name): PHILIP LOUIS MARJON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 NORDAHL RD STE 300
SAN MARCOS CA
92069-3599
US

IV. Provider business mailing address

104 WOODMONT BLVD STE 500
NASHVILLE TN
37205-2245
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-8935
  • Fax: 760-466-0078
Mailing address:
  • Phone: 615-783-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC175032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: