MEDICARE: FRED A QUENZER JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	D2569	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114916723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRED A QUENZER JR. M.D.

Provider Business Mailing Address
First Line	:	1002 LIVE OAK LN
Second Line	:
City	:	TAYLOR LAKE VILLAGE
State	:	TX
Zip	:	77586-4527
Country	:	US
Telephone Number	:	832-563-8054
Fax Number	:	281-326-4701

Provider Business Practice Location Address
First Line	:	1002 LIVE OAK LN
Second Line	:
City	:	TAYLOR LAKE VILLAGE
State	:	TX
Zip	:	77586-4527
Country	:	US
Telephone Number	:	832-563-8054
Fax Number	:	281-326-4701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	10/24/2017

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