Provider Demographics
NPI:1275732307
Name:MARQUART, WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:MARQUART
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 1:11803 SOUTH FWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7012
Mailing Address - Country:US
Mailing Address - Phone:817-293-5547
Mailing Address - Fax:817-293-8551
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE 112
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-293-5547
Practice Address - Fax:817-293-8551
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0247208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275732307Medicaid