Provider Demographics
NPI:1619973062
Name:MARQUESS, CARL W JR (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:W
Last Name:MARQUESS
Suffix:JR
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:PO BOX 7451
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7451
Mailing Address - Country:US
Mailing Address - Phone:270-443-9904
Mailing Address - Fax:270-575-0717
Practice Address - Street 1:1750 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-2706
Practice Address - Country:US
Practice Address - Phone:270-442-2744
Practice Address - Fax:270-443-5956
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21501207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64215015Medicaid
KY180028022Medicare PIN
KY1173102Medicare PIN
KY64215015Medicaid