=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386652972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILTON DOUGLAS QUIGLESS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 WASHINGTON RD CREDENTIALS OFFICE, KELLER ARMY COMMUNITY HOSPITAL
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10996-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-938-3470
-----------------------------------------------------
Fax | 845-938-6660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 WASHINGTON RD CREDENTIALS OFFICE, KELLER ARMY COMMUNITY HOSPITAL
-----------------------------------------------------
City | WEST POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10996-1109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-938-3470
-----------------------------------------------------
Fax | 845-938-6660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175L00000X
-----------------------------------------------------
Taxonomy Name | Homeopath
-----------------------------------------------------
License Number | 22432
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------