Individual
HECTOR MARQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2204 WILBORN AVE, SOUTH BOSTON, VA 24592-1645
(434) 517-3139
(434) 572-6716
Mailing address
PO BOX 444, SOUTH BOSTON, VA 24592-0444
(434) 572-3323
(434) 572-6716
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101050274
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
077059
ANTHEM BCBS
VA
05
—
5701180
—
VA
01
—
890515Z
MEDICAID OF NORTH CAROLIN
NC
Enumeration date
05/18/2006
Last updated
08/18/2011
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