MEDICARE: MR. JOHN EDWARD MARQUEZ PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	1594	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023153723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN EDWARD MARQUEZ PAC

Provider Business Mailing Address
First Line	:	PO BOX 566
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80151-0566
Country	:	US
Telephone Number	:	303-668-5231
Fax Number	:	720-920-9791

Provider Business Practice Location Address
First Line	:	3330 S BROADWAY
Second Line	:	UNIT 566
City	:	ENGLEWOOD
State	:	CO
Zip	:	80151-3301
Country	:	US
Telephone Number	:	303-668-5231
Fax Number	:	720-920-9791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	02/12/2016

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