Provider Demographics
NPI:1013124965
Name:QUIMBY, BENJAMIN LOWELL
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LOWELL
Last Name:QUIMBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14647 540TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST CONCORD
Mailing Address - State:MN
Mailing Address - Zip Code:55985-3600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14647 540TH ST
Practice Address - Street 2:
Practice Address - City:WEST CONCORD
Practice Address - State:MN
Practice Address - Zip Code:55985-3600
Practice Address - Country:US
Practice Address - Phone:507-527-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical