Healthcare Provider Details

I. General information

NPI: 1053460220
Provider Name (Legal Business Name): M JEFFREY MARCUS MD FACS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 MEDICAL CT E
INVERNESS FL
34452-4623
US

IV. Provider business mailing address

821 MEDICAL CT E
INVERNESS FL
34452-4623
US

V. Phone/Fax

Practice location:
  • Phone: 352-726-3131
  • Fax: 888-491-4367
Mailing address:
  • Phone: 352-726-3131
  • Fax: 352-726-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME20810
License Number StateFL

VIII. Authorized Official

Name: M JEFFREY MARCUS
Title or Position: MEDICAL PHYSICIAN
Credential:
Phone: 352-726-3131