Provider Demographics
NPI:1720412497
Name:MARQUEZ, DAVID R (DVM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10735 ENDURING FREEDOM DRIVE
Mailing Address - Street 2:FORT DRUM VETERINARY SERVICES
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602
Mailing Address - Country:US
Mailing Address - Phone:315-772-4265
Mailing Address - Fax:315-772-3407
Practice Address - Street 1:10735 ENDURING FREEDOM DRIVE
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602
Practice Address - Country:US
Practice Address - Phone:315-772-4265
Practice Address - Fax:315-772-3407
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012695-1174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian