Provider Demographics
NPI:1720020639
Name:IAQUINTO, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:IAQUINTO
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:3 MEDICAL PARK
Practice Address - Street 2:STE. 330
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-296-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005010201207X00000X, 207XX0801X
SC30693207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO01-0838370OtherCOVENTRY
MO207429408Medicaid
MO35477015OtherBCBS(PHP) RMC LOCATION
MO56779OtherHEALTHCARE USA-MIDWEST LO
KS200326830AMedicaid
MO35477025OtherBCBS(PHP) MIDWEST TRAUMA
MO4403943OtherAETNA
MO76-0726650OtherHUMANA
KS200326830BMedicaid
SC306939Medicaid
MO925760OtherFIRST GUARD-RMC LOCATION
MO56779OtherHEALTHCARE USA-MIDWEST LO
MO35477025OtherBCBS(PHP) MIDWEST TRAUMA
MO4403943OtherAETNA
SC306939Medicaid
MOT41E137Medicare PIN