Basic Information
| Provider Information | |||||||||
| NPI: | 1376804229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUAM | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1214 S GRANT RD | ||||||||
| Address2: | |||||||||
| City: | CARROLL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 514013102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127921500 | ||||||||
| FaxNumber: | 7127927597 | ||||||||
| Practice Location | |||||||||
| Address1: | 1214 S GRANT RD | ||||||||
| Address2: | |||||||||
| City: | CARROLL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 514013102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7127921500 | ||||||||
| FaxNumber: | 7127927597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04491 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.