Healthcare Provider Details

I. General information

NPI: 1447454103
Provider Name (Legal Business Name): KEVIN JAMES QUIGLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 TECHNOLOGY DR STE 130
O FALLON MO
63368-7342
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-0400
  • Fax: 636-916-9456
Mailing address:
  • Phone: 636-695-0400
  • Fax: 636-916-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2009001467
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2009001467
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: