Healthcare Provider Details

I. General information

NPI: 1992885297
Provider Name (Legal Business Name): JEFFREY SCOTT QUINTANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N MAYFAIR RD PAIN MANAGEMENT CLINIC
MILWAUKEE WI
53226-3462
US

IV. Provider business mailing address

10000 W INNOVATION DR SUITE 300
MILWAUKEE WI
53226-4837
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-7600
  • Fax: 414-955-6020
Mailing address:
  • Phone: 414-456-5006
  • Fax: 414-456-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number52396
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: