Provider Demographics
NPI:1790730620
Name:MARQUEZ, JOSE' ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE'
Middle Name:ANTONIO
Last Name:MARQUEZ
Suffix:
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 1:1521 ALTON RD
Mailing Address - Street 2:358
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3301
Mailing Address - Country:US
Mailing Address - Phone:305-532-9411
Mailing Address - Fax:305-532-9410
Practice Address - Street 1:590 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1962
Practice Address - Country:US
Practice Address - Phone:305-769-1830
Practice Address - Fax:305-769-2715
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 495172084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU60476Medicare UPIN
FL11484Medicare ID - Type Unspecified