Healthcare Provider Details

I. General information

NPI: 1720412497
Provider Name (Legal Business Name): DAVID R MARQUEZ DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10735 ENDURING FREEDOM DRIVE
FORT DRUM NY
13602
US

IV. Provider business mailing address

10735 ENDURING FREEDOM DRIVE FORT DRUM VETERINARY SERVICES
FORT DRUM NY
13602
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-4265
  • Fax: 315-772-3407
Mailing address:
  • Phone: 315-772-4265
  • Fax: 315-772-3407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number012695-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: