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NPI Code Detail

MEDICARE: DR. CAROLYN QUAN MD

MEDICARE: DR. CAROLYN QUAN MD
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
1208M00000XHospitalist PhysicianJ6674TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
184238SOTHERTXBCBS

General Provider Information

NPI Number : 1154351427
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLYN QUAN MD
Provider Business Mailing Address
First Line : 3600 GASTON AVE
Second Line : #550
City : DALLAS
State : TX
Zip : 75246-1904
Country : US
Telephone Number : 214-821-1177
Fax Number : 214-821-1193
Provider Business Practice Location Address
First Line : 3600 GASTON AVE
Second Line : #550
City : DALLAS
State : TX
Zip : 75246-1904
Country : US
Telephone Number : 214-821-1177
Fax Number : 214-821-1193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 10/16/2007

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Directions to “ DR. CAROLYN QUAN MD” Practice Location

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