MEDICARE: BENJAMIN PANGLAO MARQUEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0070788	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	LM607	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31492A	OTHER	FL	BCBS
3	5395218	OTHER	FL	AETNA
5	0146941	OTHER	FL	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235147182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN PANGLAO MARQUEZ MD

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	953 E DEL WEBB BLVD
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6669
Country	:	US
Telephone Number	:	813-634-6880
Fax Number	:	813-634-6833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/26/2020

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