Provider Demographics
NPI:1902995137
Name:MARCUS, TAMARA EVE (DPM)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:EVE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2641 BOX CANYON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0423
Mailing Address - Country:US
Mailing Address - Phone:702-243-3668
Mailing Address - Fax:702-243-3324
Practice Address - Street 1:2641 BOX CANYON DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0423
Practice Address - Country:US
Practice Address - Phone:702-243-3668
Practice Address - Fax:702-243-3324
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8704213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102808Medicaid
NVVDPM8704Medicare PIN
NVE16358Medicare UPIN
NV002102808Medicaid