Provider Demographics
NPI:1295717759
Name:MARQUARDT, DONALD NILAN (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:NILAN
Last Name:MARQUARDT
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Gender:M
Credentials:PHD, MD
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Mailing Address - Street 1:267 N MAIN ST
Mailing Address - Street 2:MOAB IMMEDIATE CARE AND XRAY
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2342
Mailing Address - Country:US
Mailing Address - Phone:435-259-5276
Mailing Address - Fax:435-259-5277
Practice Address - Street 1:267 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2342
Practice Address - Country:US
Practice Address - Phone:435-259-5276
Practice Address - Fax:435-259-5277
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA25816207Q00000X
WAMD00028844207Q00000X
UT162396-1205207Q00000X
AK4879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63419Medicare UPIN