Basic Information
| Provider Information | |||||||||
| NPI: | 1275186165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUEBODEAUX | ||||||||
| FirstName: | QUINN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12736 CRANE RD | ||||||||
| Address2: | |||||||||
| City: | KAPLAN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705487001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3376520354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1402 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | KAPLAN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705482918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372856033 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2019 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2019023776 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 332738 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.