Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 020458 | GA |
NPI | 1023135134 |
---|---|
Provider Name | Ramon R Marquez |
First Address | Jonesboro, GA 30236-1503 |
Second Address | Jonesboro, GA 30236-1503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10033953 | AMERIGROUP (01) | GA |
D40548 | (02) | GA |