Provider Demographics
NPI:1649223462
Name:MCQUISTON, SAMUEL A JR (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:MCQUISTON
Suffix:JR
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-471-7150
Mailing Address - Fax:251-471-7008
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7150
Practice Address - Fax:251-471-7008
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL248542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274819300Medicaid
AL51533229OtherBLUE CROSS
ALP00244978OtherRAILROAD MEDICARE PTAN
AL51529665OtherBLUE CROSS
AL17-10678OtherUNITED HEALTH CARE
AL51529668OtherBCBS - 575 STANTON RD
MS07134073Medicaid
AL51590613OtherBCBS - 1700 CENTER ST
AL009932016Medicaid
AL009932017Medicaid
LA1722219Medicaid
AL51593343OtherBCBS - 1504 SPRINGHILL AVE
H86849Medicare UPIN
LA1722219Medicaid