MEDICARE: JONATHAN CARL O'QUINN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	483	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0810Y	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1811948607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN CARL O'QUINN DPM

Provider Business Mailing Address
First Line	:	2140 W ARLINGTON BLVD
Second Line	:	STE D
City	:	GREENVILLE
State	:	NC
Zip	:	27834-0000
Country	:	US
Telephone Number	:	252-830-1000
Fax Number	:	252-830-0511

Provider Business Practice Location Address
First Line	:	2140 W ARLINGTON BLVD
Second Line	:	STE D
City	:	GREENVILLE
State	:	NC
Zip	:	27834-0000
Country	:	US
Telephone Number	:	252-830-1000
Fax Number	:	252-830-0511

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	09/11/2013

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