Healthcare Provider Details

I. General information

NPI: 1063432847
Provider Name (Legal Business Name): PRECIOUS J MARQUART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 SE JOHN JONES DR STE 110
BURLESON TX
76028-8355
US

IV. Provider business mailing address

1000 W CANNON ST
FORT WORTH TX
76104-3029
US

V. Phone/Fax

Practice location:
  • Phone: 817-725-7880
  • Fax: 817-725-7885
Mailing address:
  • Phone: 817-877-5858
  • Fax: 817-335-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD428788
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN1389
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: