Provider Demographics
NPI:1629079926
Name:QUINONES, DEOGRACIA (MD)
Entity Type:Individual
Prefix:
First Name:DEOGRACIA
Middle Name:
Last Name:QUINONES
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:WOMACK ARMY MEDICAL CTR
Mailing Address - Street 2:STOP A, 2817 REILLY ROAD
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-8664
Mailing Address - Fax:910-907-7762
Practice Address - Street 1:WOMACK ARMY MEDICAL CTR
Practice Address - Street 2:STOP A, 2817 REILLY ROAD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8664
Practice Address - Fax:910-907-7762
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35729174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131WRMedicaid
NCH73557Medicare UPIN
NC89131WRMedicaid