MEDICARE: MR. SETH QUINN

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	208600000X	Surgery Physician	V6380	TX
2	208600000X	Surgery Physician	240013	NC
3	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V6380	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1265965230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SETH QUINN

Provider Business Mailing Address
First Line	:	PO BOX 751069
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-7201
Country	:	US
Telephone Number	:	214-648-3111
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	12/30/2025

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