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SUSAN BETH MARCUS OROFACIAL MYOLOGIST

>> Specialist >> Other Service Providers

Registrant NPI Number: 1376862904

Individual Registrant:
 SUSAN BETH MARCUS OROFACIAL MYOLOGIST
Gender: F
Sole Proprietor

Location and contact information for practice:
719 PINELLAS BAYWAY S UNIT 201 TIERRA VERDE, FL 33715 US
Tel: 727-954-6733  Fax: 309-405-6496

Contact information for business:
4905 34TH STREET SOUTH #154 ST PETERSBURG, FL 33711 US
Tel: 727-954-6733  Fax: 309-405-6496

Registration Information:
NPI: 1376862904
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y174400000XOther Service Providers
Specialist

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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