1053449496 NPI number — DR. ROBERT JEFFREY MARCUS D.M.D.

Table of content: DR. ROBERT JEFFREY MARCUS D.M.D. (NPI 1053449496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053449496 NPI number — DR. ROBERT JEFFREY MARCUS D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCUS
Provider First Name:
ROBERT
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053449496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12630 MONTE VISTA RD
Provider Second Line Business Mailing Address:
# 109
Provider Business Mailing Address City Name:
POWAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-675-2285
Provider Business Mailing Address Fax Number:
858-675-9015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12630 MONTE VISTA RD
Provider Second Line Business Practice Location Address:
# 109
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-675-2285
Provider Business Practice Location Address Fax Number:
858-675-9015
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  44026 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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