Provider Demographics
NPI:1700803756
Name:MARQUEZ, HENRY C (MD)
Entity type:Individual
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First Name:HENRY
Middle Name:C
Last Name:MARQUEZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1605 E BROADWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-256-7700
Mailing Address - Fax:
Practice Address - Street 1:3700 W 10TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2540
Practice Address - Country:US
Practice Address - Phone:660-827-1771
Practice Address - Fax:660-827-1422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2021-03-19
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Provider Licenses
StateLicense IDTaxonomies
MOMO103636207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204797104Medicaid
MO204797104Medicaid