Provider Demographics
NPI:1679552400
Name:MARQUIS, DAVID (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MARQUIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 534213
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4213
Mailing Address - Country:US
Mailing Address - Phone:305-651-2770
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:21644 STATE ROAD 7
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1842
Practice Address - Country:US
Practice Address - Phone:561-488-8000
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007851207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00149967OtherRRMCR
P00451256OtherRR MCR
FL260587200Medicaid
FL58715OtherBCBS
FL58715OtherBCBS
P00451256OtherRR MCR
FLP00149967OtherRRMCR