Basic Information
| Provider Information | |||||||||
| NPI: | 1447219688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 6TH ST STE 256 | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376202257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2345731502 | ||||||||
| FaxNumber: | 4232170604 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 6TH ST STE 256 | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376202257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2345731502 | ||||||||
| FaxNumber: | 4232170604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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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 | 207R00000X | 24122 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 24122 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101234588 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010101701 | 05 | VA | MEDICAID | 3072748 | 05 | TN | MEDICAID |