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NPI Code Detail

MEDICARE: DR. RAINER QUIJADA CHAN M.D.

MEDICARE: DR. RAINER QUIJADA CHAN 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
1207Q00000XFamily Medicine PhysicianME99142FL

General Provider Information

NPI Number : 1972794790
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RAINER QUIJADA CHAN M.D.
Provider Business Mailing Address
First Line : 900 49TH ST N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33710-6625
Country : US
Telephone Number : 813-915-5459
Fax Number : 727-201-4147
Provider Business Practice Location Address
First Line : 900 49TH ST N
Second Line :
City : ST PETERSBURG
State : FL
Zip : 33710-6625
Country : US
Telephone Number : 813-915-5459
Fax Number : 727-201-4147
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2007
Last Update Date : 09/28/2018

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