Healthcare Provider Details

I. General information

NPI: 1316803711
Provider Name (Legal Business Name): MARQUIS THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

4510 IRONTON AVE APT 5204
LUBBOCK TX
79407-3785
US

V. Phone/Fax

Practice location:
  • Phone: 210-374-4229
  • Fax:
Mailing address:
  • Phone: 210-374-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: