Provider Demographics
NPI:1558470229
Name:QUIMBY, JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:QUIMBY
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:PO BOX 221221
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-1221
Mailing Address - Country:US
Mailing Address - Phone:907-561-9191
Mailing Address - Fax:907-561-0097
Practice Address - Street 1:9150 JEWEL LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5381
Practice Address - Country:US
Practice Address - Phone:907-333-8561
Practice Address - Fax:907-333-8560
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD01603Medicaid
AKMD01603Medicaid