Healthcare Provider Details

I. General information

NPI: 1497977607
Provider Name (Legal Business Name): DAVID KEITH MARCOUX PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CASSON HILL RD
FORT RILEY KS
66442-7037
US

IV. Provider business mailing address

600 CASSON HILL RD
FORT RILEY KS
66442-7037
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7155
  • Fax: 740-687-9059
Mailing address:
  • Phone: 785-239-7155
  • Fax: 740-687-9059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50001064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: