Provider Demographics
NPI:1245239342
Name:QUINNEY, BEN H JR (MD)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:H
Last Name:QUINNEY
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:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134-0506
Mailing Address - Country:US
Mailing Address - Phone:318-239-4860
Mailing Address - Fax:805-295-4715
Practice Address - Street 1:850 OLIVE ST STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2162
Practice Address - Country:US
Practice Address - Phone:318-239-4860
Practice Address - Fax:805-295-4715
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-11-07
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
LA011157207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136816Medicaid
LA1136816Medicaid
LA5K956Medicare PIN
LA5DB72Medicare PIN
LAB61132Medicare UPIN