Provider Demographics
NPI:1306877766
Name:MARQUEZ, RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 MCCULLOUGH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1630
Mailing Address - Country:US
Mailing Address - Phone:210-271-3203
Mailing Address - Fax:210-733-6983
Practice Address - Street 1:6800 W IH 10
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2011
Practice Address - Country:US
Practice Address - Phone:210-271-3203
Practice Address - Fax:210-733-6983
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04118363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y0397OtherBCBS
TXTXB117166Medicare PIN
Q24917Medicare UPIN
TX8Y0397OtherBCBS