Individual
TIMOTHY MARCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15790 PAUL VEGA MD DR, HAMMOND, LA 70403-1434
(985) 230-1683
(985) 230-6652
Mailing address
14104 LILLY PAD POND RD, AMITE, LA 70422-2333
(985) 514-5522
(985) 230-6652
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
330273
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083174817
NPI
LA
Enumeration date
03/20/2019
Last updated
06/28/2022
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