Provider Demographics
NPI:1881674380
Name:QUINONES, LUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:QUINONES
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 1:619 SOUTH MARION AVENUE
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS NORTH FLORIDA/SOUTH GEOR
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:386-755-3016
Mailing Address - Fax:386-754-6484
Practice Address - Street 1:619 SOUTH MARION AVENUE
Practice Address - Street 2:NF/SG VETERANS HEALTH SYSTEM
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-754-6384
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL431 ACN174400000X
PR14915208D00000X, 207P00000X, 171100000X, 2083X0100X
FLACN431208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No174400000XOther Service ProvidersSpecialist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I04547Medicare UPIN
0022347Medicare ID - Type Unspecified