Provider Demographics
NPI:1366452799
Name:ANDERSON, QUENTIN N (MD)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:N
Last Name:ANDERSON
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 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-3500
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-694-4034
Practice Address - Fax:520-694-0216
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ333672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00476012OtherRAILROAD MEDICARE
AZZWCGCROtherGROUP MEDICARE PIN
AZ263369Medicaid
AZZWCGCROtherGROUP MEDICARE PIN
AZP00476012OtherRAILROAD MEDICARE