Healthcare Provider Details

I. General information

NPI: 1720004807
Provider Name (Legal Business Name): LAWRENCE I MARCUS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW 13TH ST SUITE 1 A
BOCA RATON FL
33486-2337
US

IV. Provider business mailing address

951 NW 13TH ST SUITE 1 A
BOCA RATON FL
33486-2337
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-9933
  • Fax:
Mailing address:
  • Phone: 561-368-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME15257
License Number StateFL

VIII. Authorized Official

Name: DR. LAWRENCE IRVING MARCUS
Title or Position: DOCTOR
Credential: MD
Phone: 561-368-9933