Healthcare Provider Details

I. General information

NPI: 1881936342
Provider Name (Legal Business Name): ERIC ALBERTO MARQUEZ GUERRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERIC ALBERTO MARQUEZ-GUERRA MD

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 NE METHODIST TER
LAKE CITY FL
32055-3408
US

IV. Provider business mailing address

2221 NORTH BLVD W
DAVENPORT FL
33837-8990
US

V. Phone/Fax

Practice location:
  • Phone: 386-292-7844
  • Fax:
Mailing address:
  • Phone: 863-421-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number029902-R
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME131544
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: