Provider Demographics
NPI:1104092832
Name:RAYMOND J. MARQUETTE MD PA
Entity type:Organization
Organization Name:RAYMOND J. MARQUETTE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-622-2229
Mailing Address - Street 1:1800 SE 17TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4191
Mailing Address - Country:US
Mailing Address - Phone:352-622-2229
Mailing Address - Fax:352-351-0604
Practice Address - Street 1:1800 SE 17TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4191
Practice Address - Country:US
Practice Address - Phone:352-622-2229
Practice Address - Fax:352-351-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276814300Medicaid