Provider Demographics
NPI:1639164114
Name:QUAST, DON C (MD, PA)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:C
Last Name:QUAST
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:STE 560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-521-0017
Mailing Address - Fax:713-521-0240
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:STE 560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-521-0017
Practice Address - Fax:713-521-0240
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032093902Medicaid
TX0320939-01Medicaid
TX000000B479OtherBC/BS
TX00B479Medicare ID - Type Unspecified
TX032093902Medicaid
TXB25710Medicare UPIN