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General NPI Number Information
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NPI Number | 1992882419
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Entity Type | Individual
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Provider Name | JEFFERSON QUALLS MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 301 HENRY ST
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City | NORTH VERNON
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State | IN
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Zip | 47265-1030
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Country | US
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Telephone | 317-695-1241
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 N 500 W
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City | BARGERSVILLE
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State | IN
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Zip | 46106-9251
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Country | US
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Telephone | 317-695-1241
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01037759
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01037759A
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License Number State | IN
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