Provider Demographics
NPI:1326185257
Name:QUERTERMOUS, JOHN REED (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:REED
Last Name:QUERTERMOUS
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 1:205 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2402
Mailing Address - Country:US
Mailing Address - Phone:270-753-5161
Mailing Address - Fax:270-753-1846
Practice Address - Street 1:205 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2402
Practice Address - Country:US
Practice Address - Phone:270-753-5161
Practice Address - Fax:270-753-1846
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19950173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64199508Medicaid
KYC63599Medicare UPIN
KY1312801Medicare ID - Type Unspecified