MEDICARE: ROXY MARRESE JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0025420	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629076039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXY MARRESE JR. M.D.

Provider Business Mailing Address
First Line	:	3911 S NOVA RD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4910
Country	:	US
Telephone Number	:	386-258-4840
Fax Number	:	386-255-0140

Provider Business Practice Location Address
First Line	:	201 N CLYDE MORRIS BLVD
Second Line	:	SUITE 240
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2724
Country	:	US
Telephone Number	:	386-258-4840
Fax Number	:	386-255-0140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/08/2007

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Directions to “ ROXY MARRESE JR. M.D.” Practice Location

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