Provider Demographics
NPI:1275186165
Name:QUEBODEAUX, QUINN ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:ALLEN
Last Name:QUEBODEAUX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12736 CRANE RD
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-7001
Mailing Address - Country:US
Mailing Address - Phone:337-652-0354
Mailing Address - Fax:
Practice Address - Street 1:1402 W 8TH ST
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-2918
Practice Address - Country:US
Practice Address - Phone:337-285-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019023776207Q00000X
LA332738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine