Healthcare Provider Details

I. General information

NPI: 1285702597
Provider Name (Legal Business Name): MARK ALAN QUIST DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16419 NORTHCROSS DR SUITE A
HUNTERSVILLE NC
28078-5004
US

IV. Provider business mailing address

16419 NORTHCROSS DR SUITE A
HUNTERSVILLE NC
28078-5004
US

V. Phone/Fax

Practice location:
  • Phone: 704-987-9585
  • Fax: 704-987-9589
Mailing address:
  • Phone: 704-987-9585
  • Fax: 704-987-9589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number424
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: