Provider Demographics
NPI:1508905407
Name:BENJAMIN P MARQUEZ MD PA
Entity Type:Organization
Organization Name:BENJAMIN P MARQUEZ MD PA
Other - Org Name:MARQUEZ MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PANGLAO
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-634-6880
Mailing Address - Street 1:953 DEL WEBB BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6669
Mailing Address - Country:US
Mailing Address - Phone:813-634-6880
Mailing Address - Fax:813-634-6833
Practice Address - Street 1:953 DEL WEBB BLVD EAST
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31492OtherBCBS
FL251410901Medicaid
FL31492AMedicare ID - Type Unspecified
FLG28707Medicare UPIN