Provider Demographics
NPI:1477609881
Name:QUEBBEMANN, BRIAN BERNARD (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:BERNARD
Last Name:QUEBBEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10 TAHOE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2224
Mailing Address - Country:US
Mailing Address - Phone:949-722-7662
Mailing Address - Fax:
Practice Address - Street 1:12791 NEWPORT AVENUE
Practice Address - Street 2:SUITE 208
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8023
Practice Address - Country:US
Practice Address - Phone:949-722-7662
Practice Address - Fax:949-631-6585
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83899208600000X
CAG083899208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery