JOSE A MARROQUIN (NPI# 1598712986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598712986 |
| Entity Type | Individual |
| Full Name | JOSE A MARROQUIN |
| Credential | PA |
| Practice Address |
1900 Woodland Dr Coos Bay OR 97420-2045 |
| Practice Telephone | 5412675151 |
| Practice Fax Number | 5412664541 |
| Mailing Telephone | 5412675151 |
| Mailing Fax Number | 5412664541 |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2010-12-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA00273 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | BLUE CROSS | 050922005 | 01 |
| OR | TRICARE | 97420A003 | 01 |
| OR | NBMC MAIN - GROUP MEDICARE NUMBER | R0000WFBTV | 01 |
| OR | RAIL ROAD MEDICARE | 970002408 | 01 |
| OR | NBMC MAIN GROUP NPI NUMBER | 1407812365 | 01 |
| NBMC MAIN GROUP TAX ID FOR BILLING | 93-0635514 | 01 | |
| OR | NBMC MAIN GROUP DMAP NUMBER | 161133 | 01 |
| OR | PACIFIC SOURCE | C105010 | 01 |
| OR | SUPERVISING PHYSICIAN OR LICENSE- DR. RICHARD JANY | MD16946 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457832719 | Jose Marroquin | Technician | 8948 Attic Grace Ave, Las Vegas, NV 89149-3002 | 2018-08-24 |
| Street Address |
1900 WOODLAND DR |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-2045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174517528 | Mary Irene Hernandez | Physical Therapist | 1900 Woodland Dr, Coos Bay, OR 97420 | 2005-08-31 |
| 1477189009 | Sandy Lynn Teeter | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2020-03-16 |
| 1114564630 | Mitaliben Rajendrakumar Gor | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-12-03 |
| 1568014942 | Nikkona Henderson | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2019-07-15 |
| 1861050189 | James Murray | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-06-01 |
| 1346803640 | Sophia Elizabeth Massey | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2019-04-22 |
| 1750857090 | Alaina Therese Hendrix | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-10-14 |
| 1801382155 | Yulia Viktorovna Whidden | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-07-10 |
| 1124525043 | Samantha Decker | Dermatology | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2018-04-07 |
| 1043712383 | Gregory Sopka | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2018-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225511322 | Kylie Webb Tresher Winquist | Physician Assistant | 1775 Thompson Rd, Coos Bay, OR 97420-2125 | 2018-09-13 |
| 1043712383 | Gregory Sopka | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2018-03-02 |
| 1477052470 | Magdalene Clare Shaughnessy | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2018-02-05 |
| 1639626724 | Nicole Fennell | Physician Assistant | 1775 Thompson Rd, Coos Bay, OR 97420-2125 | 2016-09-06 |
| 1831410455 | Alice Rachel Stappler | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2010-06-17 |
| 1700112646 | Christopher Hales Riehl | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2009-10-28 |
| 1932433190 | Hazen Timothy Herzog | Physician Assistant | 1900 Woodland Dr, Coos Bay, OR 97420-2045 | 2009-09-21 |
| 1629092861 | Tannis Bolton | Physician Assistant | 1775 Thompson Rd, Coos Bay, OR 97420-2125 | 2006-07-27 |
| 1407800097 | Clifford S Lance | Physician Assistant | 2699 N 17th St, Coos Bay, OR 97420-2134 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801495569 | Lynsie Wolfe | Physician Assistant | 3000 Bryant Williams Dr Ste 200, Klamath Falls, OR 97601-1140 | 2020-10-22 |
| 1548867856 | Megan Elaine Stewart | Physician Assistant | 3773 Pinetop Dr, Medford, OR 97504-9638 | 2020-10-08 |
| 1639786411 | Bridget Meade-sentosun | Physician Assistant | 2599 Ne Overlook Dr Apt 815, Hillsboro, OR 97124-7613 | 2020-09-25 |
| 1518570738 | Samantha Larelle Williamson | Physician Assistant | 1551 2nd St, Umatilla, OR 97882-9707 | 2020-08-27 |
| 1356951891 | Eric James Humphrey | Physician Assistant | 1055 Ne Creeksedge Dr, Hillsboro, OR 97124-1316 | 2020-08-07 |
| 1427676493 | Lindsey Louise Peterson | Physician Assistant | 3505 N Williams Ave, Portland, OR 97227-1437 | 2020-07-07 |
| 1871110361 | Dana Sierra Jackson | Physician Assistant | 370 Ne Garner St, Prineville, OR 97754-2039 | 2020-06-30 |
| 1518584036 | Abigail Nichole Dumont | Physician Assistant | 6064 Sw 30th Ave, Portland, OR 97239-1018 | 2020-06-30 |
| 1831712280 | Joshua Sprague | Physician Assistant | 6501 Ne Cherry Dr Apt 1112, Hillsboro, OR 97124-7711 | 2020-05-20 |
| 1376165134 | Emily Axelrod | Physician Assistant | 19648 Wildwood Dr, West Linn, OR 97068-2210 | 2020-05-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.