Healthcare Provider Details

I. General information

NPI: 1902135460
Provider Name (Legal Business Name): MARSHALL REID NAQUIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2009
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52579 HIGHWAY 51 S
INDEPENDENCE LA
70443-2231
US

IV. Provider business mailing address

258 LAKE BREEZE DR
BATON ROUGE LA
70820-5330
US

V. Phone/Fax

Practice location:
  • Phone: 985-878-9421
  • Fax:
Mailing address:
  • Phone: 337-889-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number206625
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: