Healthcare Provider Details

I. General information

NPI: 1912989575
Provider Name (Legal Business Name): TIMOTHY ROBERT QUINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NW KINGS BLVD
CORVALLIS OR
97330-3900
US

IV. Provider business mailing address

2400 NW KINGS BLVD
CORVALLIS OR
97330-3900
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-2400
  • Fax: 541-752-0931
Mailing address:
  • Phone: 541-757-2400
  • Fax: 541-752-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101051336
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: