Provider Demographics
NPI:1659392983
Name:QUEBEDEAUX, ANTHONY JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:QUEBEDEAUX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 WINNE AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4917
Mailing Address - Country:US
Mailing Address - Phone:406-442-8111
Mailing Address - Fax:406-442-4902
Practice Address - Street 1:2646 WINNE AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4917
Practice Address - Country:US
Practice Address - Phone:406-442-8111
Practice Address - Fax:406-442-4902
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT111213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000390702Medicaid
U42901Medicare UPIN
MT480025782Medicare PIN
MT0000390702Medicaid
MT0926350001Medicare NSC