Provider Demographics
NPI:1043215965
Name:QUINONES, EVARISTO (MD)
Entity Type:Individual
Prefix:DR
First Name:EVARISTO
Middle Name:
Last Name:QUINONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 CALLE MARINA
Mailing Address - Street 2:MANS PLAYA HUCARES
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-2875
Mailing Address - Country:US
Mailing Address - Phone:580-695-6422
Mailing Address - Fax:787-874-4292
Practice Address - Street 1:4303 PITMAN & THOMAS RD
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-585-5640
Practice Address - Fax:580-585-5680
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKGO2805Medicare UPIN
OK8HZ232Medicare ID - Type Unspecified