Healthcare Provider Details

I. General information

NPI: 1427065341
Provider Name (Legal Business Name): QUENTIN B EMERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7861 S PROFESSIONAL DR
FORT BRANCH IN
47648-8405
US

IV. Provider business mailing address

PO BOX 185
FORT BRANCH IN
47648-0185
US

V. Phone/Fax

Practice location:
  • Phone: 812-753-4181
  • Fax: 812-753-4399
Mailing address:
  • Phone: 812-753-4181
  • Fax: 812-753-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01027038
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: