Provider Demographics
NPI:1083612527
Name:MARQUEZ, LUIS GILBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GILBERTO
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 AVE FERNANDEZ JUNCOS
Mailing Address - Street 2:APT. 602
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-4131
Mailing Address - Country:US
Mailing Address - Phone:787-725-0449
Mailing Address - Fax:
Practice Address - Street 1:651 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:APT. 602
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4131
Practice Address - Country:US
Practice Address - Phone:787-725-0449
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12034208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G37216Medicare UPIN