1912000837 NPI number — L DARRYL QUARLES M.D.

Table of content: L DARRYL QUARLES M.D. (NPI 1912000837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912000837 NPI number — L DARRYL QUARLES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUARLES
Provider First Name:
L
Provider Middle Name:
DARRYL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912000837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
956 COURT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-2814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-448-4385
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
956 COURT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38103-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-448-4385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  04-30604 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003181810A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209360106 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34097019 . This is a "BCBS KC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 180641001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912000837 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1515166 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200264870A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00453855 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179834 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 925247 . This is a "FIRSTGUARD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com