Provider Demographics
NPI:1023153723
Name:MARQUEZ, JOHN EDWARD (PAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80151-0566
Mailing Address - Country:US
Mailing Address - Phone:303-668-5231
Mailing Address - Fax:720-920-9791
Practice Address - Street 1:3330 S BROADWAY
Practice Address - Street 2:UNIT 566
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80151-3301
Practice Address - Country:US
Practice Address - Phone:303-668-5231
Practice Address - Fax:720-920-9791
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1594363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79688829Medicaid
CO79688829Medicaid