Provider Demographics
NPI:1568637221
Name:MARQUESS, JOEL
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MARQUESS
Suffix:
Gender:M
Credentials:
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 70378
Mailing Address - Street 2:815 SECOND AVE, SUITE 116
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0378
Mailing Address - Country:US
Mailing Address - Phone:704-355-0221
Mailing Address - Fax:704-355-0770
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5907
Practice Address - Country:US
Practice Address - Phone:704-355-0221
Practice Address - Fax:704-355-0770
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-020642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1616059Medicaid
K165870Medicare PIN