Provider Demographics
NPI:1114916723
Name:QUENZER, FRED A JR (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:A
Last Name:QUENZER
Suffix:JR
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 1:1002 LIVE OAK LN
Mailing Address - Street 2:
Mailing Address - City:TAYLOR LAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77586-4527
Mailing Address - Country:US
Mailing Address - Phone:832-563-8054
Mailing Address - Fax:281-326-4701
Practice Address - Street 1:1002 LIVE OAK LN
Practice Address - Street 2:
Practice Address - City:TAYLOR LAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77586-4527
Practice Address - Country:US
Practice Address - Phone:832-563-8054
Practice Address - Fax:281-326-4701
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD25692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132532601Medicaid
300034267Medicare PIN
E18042Medicare UPIN
TX132532601Medicaid