Provider Demographics
NPI:1609968395
Name:PAULY, QUINN (MD)
Entity Type:Individual
Prefix:DR
First Name:QUINN
Middle Name:
Last Name:PAULY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6795 EDMOND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3505
Mailing Address - Country:US
Mailing Address - Phone:702-763-7670
Mailing Address - Fax:702-333-6588
Practice Address - Street 1:6795 EDMOND ST FL 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3505
Practice Address - Country:US
Practice Address - Phone:702-763-7670
Practice Address - Fax:702-263-0609
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11205549OtherCAQH
NV1609968395Medicaid
11205549OtherCAQH
NVFA903YMedicare PIN
NVP01170775OtherRR MEDICARE PTAN