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General NPI Number Information
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NPI Number | 1598189060
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Entity Type | Individual
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Provider Name | DAVID ALLAN QUACKENBUSH DO
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Gender | Male
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 2050A 2ND ST SE
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City | KIRTLAND AFB
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State | NM
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Zip | 87117-2502
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Country | US
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Telephone | 505-846-3200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 56853
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City | ALBUQUERQUE
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State | NM
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Zip | 87187-6853
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Country | US
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Telephone | 682-241-6707
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0102204210
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 0102204210
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License Number State | VA
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