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General NPI Number Information
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NPI Number | 1720020639
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Entity Type | Individual
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Provider Name | JOHN M IAQUINTO MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 3 MEDICAL PARK STE. 330
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City | COLUMBIA
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State | SC
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Zip | 29203
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Country | US
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Telephone | 803-296-7305
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | FORTSON
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State | GA
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Zip | 31808-0370
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Country | US
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Telephone |
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Fax | 706-494-3008
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2005010201
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 2005010201
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 30693
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License Number State | SC
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