Healthcare Provider Details

I. General information

NPI: 1548260714
Provider Name (Legal Business Name): GREGORY A QUIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GREGORY A QUIN MD

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N DUKE STREET
PERU IN
46970-1520
US

IV. Provider business mailing address

302 N DUKE STREET
PERU IN
46970-1520
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-3944
  • Fax: 765-472-3945
Mailing address:
  • Phone: 765-472-3944
  • Fax: 765-472-3945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number1045818
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: