Provider Demographics
NPI:1447405808
Name:RICHARD G QUIST, MD MEDICAL CORPORATION INC.
Entity Type:Organization
Organization Name:RICHARD G QUIST, MD MEDICAL CORPORATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:QUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-645-8300
Mailing Address - Street 1:361 HOSPITAL RD
Mailing Address - Street 2:STE 331
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-645-8300
Mailing Address - Fax:949-645-0200
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:STE 331
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-645-8300
Practice Address - Fax:949-645-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65910207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty