Provider Demographics
NPI:1750677860
Name:MARQUEZ, ELIZABETH J (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:MARQUEZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:145 HILDEN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8403
Mailing Address - Country:US
Mailing Address - Phone:904-468-6064
Mailing Address - Fax:904-342-5274
Practice Address - Street 1:145 HILDEN RD STE 120
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8403
Practice Address - Country:US
Practice Address - Phone:904-460-6064
Practice Address - Fax:904-342-5274
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2024-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME117715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01744319OtherRR MEDICARE
FLHV853YMedicare PIN