Provider Demographics
NPI:1629077326
Name:QUARLES, JAMES D (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:QUARLES
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 1:80 C MICHAEL DAVENPORT BLVD. STE A.
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4399
Mailing Address - Country:US
Mailing Address - Phone:502-227-8681
Mailing Address - Fax:502-223-7046
Practice Address - Street 1:80 C MICHAEL DAVENPORT BLVD. STE A.
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4399
Practice Address - Country:US
Practice Address - Phone:502-227-8681
Practice Address - Fax:502-223-7046
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23513207RS0010X
KY37457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC30629OtherRAILROAD MEDICARE
KYP00172504OtherRAILROAD MEDICARE
KY65934895Medicaid
KY64069610Medicaid
KYANTHEM BCBSOther000000048740
KYC30629OtherRAILROAD MEDICARE
KY64069610Medicaid
KY0212210Medicare ID - Type Unspecified