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General NPI Number Information
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NPI Number | 1184624421
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Entity Type | Individual
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Provider Name | EDWARD J QUINN MD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 150 RIVIERA DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5735
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Country | US
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Telephone | 928-855-5090
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20610
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City | MESA
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State | AZ
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Zip | 85277-0610
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Country | US
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Telephone | 480-985-1093
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Fax | 480-296-7665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 31681
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License Number State | AZ
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