Healthcare Provider Details

I. General information

NPI: 1245238005
Provider Name (Legal Business Name): ANDREW C QUINT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W WORLEY ST
COLUMBIA MO
65203-2037
US

IV. Provider business mailing address

1001 W WORLEY ST
COLUMBIA MO
65203-2037
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-2314
  • Fax: 573-607-2885
Mailing address:
  • Phone: 573-214-2314
  • Fax: 573-607-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number112750
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number112750
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: