Healthcare Provider Details

I. General information

NPI: 1649849456
Provider Name (Legal Business Name): MARCUS DEAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 PECAN DR
ALEXANDRIA LA
71302-2547
US

IV. Provider business mailing address

3814 PECAN DR
ALEXANDRIA LA
71302-2547
US

V. Phone/Fax

Practice location:
  • Phone: 318-308-9818
  • Fax:
Mailing address:
  • Phone: 318-308-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: