Individual
JOSE A MARROQUIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4541
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5151
(541) 266-4541
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00273
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050922005
BLUE CROSS
OR
01
—
1407812365
NBMC MAIN GROUP NPI NUMBER
OR
01
—
161133
NBMC MAIN GROUP DMAP NUMBER
OR
01
—
93-0635514
NBMC MAIN GROUP TAX ID FOR BILLING
—
01
—
970002408
RAIL ROAD MEDICARE
OR
01
—
97420A003
TRICARE
OR
01
—
C105010
PACIFIC SOURCE
OR
01
—
MD16946
SUPERVISING PHYSICIAN OR LICENSE- DR. RICHARD JANY
OR
01
—
R0000WFBTV
NBMC MAIN - GROUP MEDICARE NUMBER
OR
Enumeration date
05/30/2006
Last updated
12/14/2010
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