Provider Demographics
NPI:1376804229
Name:QUAM, SHAUN STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:STEVEN
Last Name:QUAM
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 1:1214 S GRANT RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3102
Mailing Address - Country:US
Mailing Address - Phone:712-792-1500
Mailing Address - Fax:712-792-7597
Practice Address - Street 1:1214 S GRANT RD
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3102
Practice Address - Country:US
Practice Address - Phone:712-792-1500
Practice Address - Fax:712-792-7597
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine