Healthcare Provider Details

I. General information

NPI: 1023024189
Provider Name (Legal Business Name): ROBERT MARCUS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 AIRPORT BLVD SUITE 1000
PENSACOLA FL
32504-8615
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6770
  • Fax: 850-416-7770
Mailing address:
  • Phone: 850-416-6770
  • Fax: 850-416-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number029347
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number29054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: