Provider Demographics
NPI:1275696866
Name:MARQUEZ, THAO TRAN (MD,MS)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:TRAN
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MD,MS
Other - Prefix:DR
Other - First Name:THAO
Other - Middle Name:PHUONG
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 7011B
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48381208D00000X
NMMD2018-0703208600000X
MO2012029320208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery