Provider Demographics
NPI:1790755890
Name:QUINN, TIMOTHY ELLIS (IDC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ELLIS
Last Name:QUINN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CHABLIS DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1741
Mailing Address - Country:US
Mailing Address - Phone:504-678-2400
Mailing Address - Fax:
Practice Address - Street 1:NAVAL AMBULATORY CARE CENTER
Practice Address - Street 2:2300 GENERAL MEYER AV BLDG H-100
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70142-0001
Practice Address - Country:US
Practice Address - Phone:504-678-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other