Basic Information
| Provider Information | |||||||||
| NPI: | 1881674380 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINONES | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 SOUTH MARION AVENUE | ||||||||
| Address2: | DEPARTMENT OF VETERANS AFFAIRS NORTH FLORIDA/SOUTH GEOR | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867546484 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 SOUTH MARION AVENUE | ||||||||
| Address2: | NF/SG VETERANS HEALTH SYSTEM | ||||||||
| City: | LAKE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867553016 | ||||||||
| FaxNumber: | 3867546384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 431 ACN | FL | N | Other Service Providers | Specialist | 208D00000X | 14915 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 207P00000X | 14915 | PR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | ACN431 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 171100000X | 14915 | PR | N | Other Service Providers | Acupuncturist | 2083X0100X | 14915 | PR | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.