Provider Demographics
NPI:1184675647
Name:MARQUEZ, JULIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:
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 1:2140 W 68TH ST
Mailing Address - Street 2:SUITE 401-A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1815
Mailing Address - Country:US
Mailing Address - Phone:305-827-9939
Mailing Address - Fax:305-827-9918
Practice Address - Street 1:2140 W 68TH ST
Practice Address - Street 2:SUITE 401-A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-827-9939
Practice Address - Fax:305-827-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056854208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061833100Medicaid
FL09635XOtherMEDICARE PTAN
FLE75862Medicare UPIN