Healthcare Provider Details

I. General information

NPI: 1376514893
Provider Name (Legal Business Name): JAMES MARQUART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 N 19TH AVE
PHOENIX AZ
85015-1646
US

IV. Provider business mailing address

455 LIBERTY ST
ASHLAND OR
97520-3041
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-6020
  • Fax:
Mailing address:
  • Phone: 503-871-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200060018CRNA
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA0431
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: