Healthcare Provider Details

I. General information

NPI: 1346852068
Provider Name (Legal Business Name): TREVOR QUANDT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 AGENCY MAIN ST
HARLEM MT
59526-9455
US

IV. Provider business mailing address

669 AGENCY MAIN ST
HARLEM MT
59526-9455
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-3100
  • Fax:
Mailing address:
  • Phone: 406-353-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61245832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: