Basic Information
Provider Information
NPI: 1063471837
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: QUIGLEY
FirstName: TERENCE
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 720 OLIVE WAY
Address2: SUITE 1505
City: SEATTLE
State: WA
PostalCode: 981011878
CountryCode: US
TelephoneNumber: 2068382590
FaxNumber: 2062648689
Practice Location
Address1: 1560 N 115TH ST
Address2: SUITE 102
City: SEATTLE
State: WA
PostalCode: 981338414
CountryCode: US
TelephoneNumber: 2063632882
FaxNumber: 2063634172
Other Information
ProviderEnumerationDate: 03/21/2006
LastUpdateDate: 06/18/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XMD00025499WAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home