Healthcare Provider Details

I. General information

NPI: 1780655936
Provider Name (Legal Business Name): GARY E QUINBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JOHN DEERE RD SUITE 200
MOLINE IL
61265-6869
US

IV. Provider business mailing address

600 JOHN DEERE RD SUITE 200
MOLINE IL
61265-6869
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-4200
  • Fax: 309-779-4305
Mailing address:
  • Phone: 309-779-4200
  • Fax: 309-779-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036102180
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036102180
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036102180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: