Provider Demographics
NPI:1508174244
Name:MARIAN KATHLEEN QUERRY DO PC
Entity Type:Organization
Organization Name:MARIAN KATHLEEN QUERRY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:QUERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:936-462-4325
Mailing Address - Street 1:103 WINIFREDS WAY
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-6223
Mailing Address - Country:US
Mailing Address - Phone:903-331-0506
Mailing Address - Fax:903-331-0462
Practice Address - Street 1:1020 NORTH ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4406
Practice Address - Country:US
Practice Address - Phone:936-462-4325
Practice Address - Fax:936-205-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5671208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty