Provider Demographics
NPI:1821693060
Name:AUSTIN, QUENTEN EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:QUENTEN
Middle Name:EDWARD
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2017 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-3807
Mailing Address - Country:US
Mailing Address - Phone:618-792-3440
Mailing Address - Fax:
Practice Address - Street 1:SSM HEALTH ST LOUIS UNIVERSITY HOSPITAL
Practice Address - Street 2:1201 S GRAND BLVD
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-257-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant