Provider Demographics
NPI:1174605588
Name:QUINN, TANYA M (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:M
Last Name:QUINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:M
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 297A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6364
Mailing Address - Fax:314-251-7897
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 297A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6364
Practice Address - Fax:314-251-7897
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL24901207T00000X
MO2010010443207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery