Provider Demographics
NPI:1497977607
Name:MARCOUX, DAVID KEITH (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEITH
Last Name:MARCOUX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CASSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-7037
Mailing Address - Country:US
Mailing Address - Phone:785-239-7155
Mailing Address - Fax:740-687-9059
Practice Address - Street 1:600 CASSON HILL RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-7037
Practice Address - Country:US
Practice Address - Phone:785-239-7155
Practice Address - Fax:740-687-9059
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50001064OtherOHIO PA MEDICAL LICENSE
OH50001064OtherOHIO PA MEDICAL LICENSE