Provider Demographics
NPI:1124088331
Name:LUQUE, MARION LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:LYNN
Last Name:LUQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:502 W TWO RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7121
Mailing Address - Country:US
Mailing Address - Phone:208-599-3303
Mailing Address - Fax:
Practice Address - Street 1:1139 E. WINDING CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6566
Practice Address - Country:US
Practice Address - Phone:208-938-8887
Practice Address - Fax:208-938-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM8345OtherSTATE LICENSE
IDM8345OtherSTATE LICENSE
IDG79554Medicare UPIN