Provider Demographics
NPI:1124043641
Name:QUINTANA, HUGO A (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:A
Last Name:QUINTANA
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 1:4211 HOSPITAL ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5310
Mailing Address - Country:US
Mailing Address - Phone:228-372-8270
Mailing Address - Fax:228-372-8271
Practice Address - Street 1:4211 HOSPITAL ST STE 202
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5310
Practice Address - Country:US
Practice Address - Phone:228-372-8270
Practice Address - Fax:228-372-8270
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS17973207RC0000X
MS17973207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02407350Medicaid
MS04854276Medicaid
MS060000687Medicare ID - Type UnspecifiedPROVIDER NO