MEDICARE: DR. ROBERT MARCUS 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	174400000X	Specialist	G14305	CA

General Provider Information

NPI Number	:	1952706301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MARCUS M.D.

Provider Business Mailing Address
First Line	:	1603 CITY LIGHTS ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-7613
Country	:	US
Telephone Number	:	505-820-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 CITY LIGHTS ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-7613
Country	:	US
Telephone Number	:	505-820-0820
Fax Number	:

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

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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