Provider Demographics
NPI:1639263734
Name:QUIEL, EDWARD LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:QUIEL
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 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:9660 SOUTH 1300 EAST
Practice Address - Street 2:ALTA VIEW HOSPITAL
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094
Practice Address - Country:US
Practice Address - Phone:801-501-2600
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT170201-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001867100Medicaid
WY118914000Medicaid
UTQM0000075886OtherALTIUS
UT2090168OtherUNITED HEALTHCARE
UTTPRA07241OtherMOLINA
NV100501276Medicaid
UT1502954OtherUMWA
UT870545614QU2OtherEDUCATORS MUTUAL
UT10214OtherHEALTHY U
AZ822363Medicaid
UT107006515102OtherIHC
UT73534OtherPEHP
UT1502954OtherUMWA
UTP00028422Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ID001867100Medicaid