Provider Demographics
NPI:1912000837
Name:QUARLES, L DARRYL (MD)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:DARRYL
Last Name:QUARLES
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 1:956 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2814
Mailing Address - Country:US
Mailing Address - Phone:901-448-4385
Mailing Address - Fax:
Practice Address - Street 1:956 COURT AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2814
Practice Address - Country:US
Practice Address - Phone:901-448-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30604207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003181810AMedicaid
MO209360106Medicaid
MO34097019OtherBCBS KC
AR180641001Medicaid
MO1912000837Medicaid
TN1515166Medicaid
KS200264870AMedicaid
MS00453855Medicaid
AL179834Medicaid
KS925247OtherFIRSTGUARD