Healthcare Provider Details

I. General information

NPI: 1184697054
Provider Name (Legal Business Name): DEAN R QUIGLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 JASMINE ST
OMAK WA
98841-9589
US

IV. Provider business mailing address

529 JASMINE ST
OMAK WA
98841-9589
US

V. Phone/Fax

Practice location:
  • Phone: 509-826-1600
  • Fax:
Mailing address:
  • Phone: 509-826-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60476172
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: