Provider Demographics
NPI:1841724077
Name:MARQUEZ, LARRY STEVEN II
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:STEVEN
Last Name:MARQUEZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 KEOKUK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4426
Mailing Address - Country:US
Mailing Address - Phone:406-498-2290
Mailing Address - Fax:
Practice Address - Street 1:3338 KEOKUK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4426
Practice Address - Country:US
Practice Address - Phone:406-498-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT910405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional