MEDICARE: QUINTIN O LAW MD PA

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	207R00000X	Internal Medicine Physician	ME59640	FL

General Provider Information

NPI Number	:	1831379965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUINTIN O LAW MD PA

Provider Business Mailing Address
First Line	:	85 BAY BRIDGE DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4468
Country	:	US
Telephone Number	:	850-932-2000
Fax Number	:	850-932-8697

Provider Business Practice Location Address
First Line	:	85 BAY BRIDGE DR
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4468
Country	:	US
Telephone Number	:	850-932-2000
Fax Number	:	850-932-8697

Authorized Official
Title or Position	:	OWNER
Name	:	DR. QUINTIN LAW
Credential	:	M.D.
Telephone Number	:	850-932-2000

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	04/09/2008

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