Individual
MR. RUSSELL GORDON MARQUARDT SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1220 CHATBURN AVE, HARLAN, IA 51537-2009
(712) 755-5130
(712) 755-4445
Mailing address
4022 MAIN ST, ELK HORN, IA 51531
(712) 764-4642
(712) 764-4643
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
888
IA
Other
Enumeration date
07/12/2005
Last updated
12/04/2007
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