Healthcare Provider Details

I. General information

NPI: 1518353887
Provider Name (Legal Business Name): LOGAN P. MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3488 GONI RD STE 141
CARSON CITY NV
89706-7970
US

IV. Provider business mailing address

3488 GONI RD STE 141
CARSON CITY NV
89706-7970
US

V. Phone/Fax

Practice location:
  • Phone: 775-887-5030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number26418
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA147657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: