Provider Demographics
NPI:1073533683
Name:GERARDO QUINONEZ, M.D., P.A.
Entity Type:Organization
Organization Name:GERARDO QUINONEZ, M.D., P.A.
Other - Org Name:INTERNAL MEDICINE OF BOYNTON BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-369-2144
Mailing Address - Street 1:1700 W WOOLBRIGHT RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6346
Mailing Address - Country:US
Mailing Address - Phone:561-369-2144
Mailing Address - Fax:561-369-2117
Practice Address - Street 1:1700 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE #5
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6346
Practice Address - Country:US
Practice Address - Phone:561-369-2144
Practice Address - Fax:561-369-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264184400Medicaid