Provider Demographics
NPI:1235147182
Name:MARQUEZ, BENJAMIN PANGLAO (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:PANGLAO
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:953 E DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6669
Practice Address - Country:US
Practice Address - Phone:813-634-6880
Practice Address - Fax:813-634-6833
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251410901Medicaid
FL31492AOtherBCBS
FL5395218OtherAETNA
FLLM607OtherMEDICARE
FL0146941OtherCIGNA
FL5395218OtherAETNA
G28707Medicare UPIN