Individual
WALT MARQUARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3941 J STREET, SUITE 260, SACRAMENTO, CA 95819-3633
(916) 736-2323
(916) 736-0620
Mailing address
1010 HURLEY WAY, SUITE 500, SACRAMENTO, CA 95825-3216
(916) 564-3040
(916) 564-3065
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G59664
CA
207RI0011X
Interventional Cardiology Physician
Primary
G59664
CA
207UN0901X
Nuclear Cardiology Physician
G59664
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G596640
—
CA
01
—
060033947
RAILROAD MEDICARE
CA
05
—
GR0068230
—
CA
05
—
GR0068231
—
CA
05
—
GR0068232
—
CA
05
—
GR0068233
—
CA
05
—
GR0068235
—
CA
05
—
GR006823B
—
CA
01
—
ZZZ47673Z
BLUE SHIELD
CA
01
—
ZZZ47675Z
BLUE SHIELD
CA
01
—
ZZZ47676Z
BLUE SHIELD
CA
01
—
ZZZ62306Z
BLUE SHIELD
CA
Enumeration date
11/14/2006
Last updated
01/30/2015
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