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General NPI Number Information
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NPI Number | 1083639090
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Entity Type | Individual
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Provider Name | DR. DAVID E MARCUS
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1128 SONOMA AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-4806
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Country | US
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Telephone | 707-575-1626
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Fax | 707-575-3941
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Provider Business Mailing Address
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Address Line | 2491 INCLINE DR
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City | SANTA ROSA
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State | CA
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Zip | 95404-1835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G054206
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License Number State | CA
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