Provider Demographics
NPI:1861454563
Name:MARQUEZ, GUILLERMO D (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:D
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 1:910 S BRYAN RD
Mailing Address - Street 2:STE 202
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6659
Mailing Address - Country:US
Mailing Address - Phone:956-682-6126
Mailing Address - Fax:956-580-0464
Practice Address - Street 1:910 S BRYAN RD
Practice Address - Street 2:STE 202
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6659
Practice Address - Country:US
Practice Address - Phone:956-682-6126
Practice Address - Fax:956-580-0464
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1544208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030586401Medicaid
TX0054ARMedicare PIN
TXG34006Medicare UPIN