Provider Demographics
NPI:1578625729
Name:QUINN, JEROME ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ANTHONY
Last Name:QUINN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MORGAN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-9638
Mailing Address - Country:US
Mailing Address - Phone:828-658-0777
Mailing Address - Fax:828-658-1992
Practice Address - Street 1:80 MORGAN BRANCH RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9638
Practice Address - Country:US
Practice Address - Phone:828-658-0777
Practice Address - Fax:828-658-1992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908157Medicaid
NC8908157Medicaid
NC243116AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER