Provider Demographics
NPI:1235183369
Name:QUIMBY, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:QUIMBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17030 LAKESIDE HILLS PLZ
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2396
Mailing Address - Country:US
Mailing Address - Phone:402-758-5240
Mailing Address - Fax:402-758-5792
Practice Address - Street 1:17030 LAKESIDE HILLS PLZ
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2396
Practice Address - Country:US
Practice Address - Phone:402-758-5240
Practice Address - Fax:402-758-5792
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23531207RI0200X
IA37651207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081309213Medicaid
SD7721460Medicaid
IA0719955Medicaid
NE$$$$$$$$$OtherCHAMPUS
SD7721460Medicaid
NEP00319740Medicare PIN
NECI1685Medicare PIN