Provider Demographics
NPI:1023048626
Name:QUINN, BRIAN (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:641-683-0800
Mailing Address - Fax:641-683-0801
Practice Address - Street 1:522 N HANCOCK ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4231
Practice Address - Country:US
Practice Address - Phone:641-683-0800
Practice Address - Fax:641-683-0801
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015800207Q00000X
IADO-03851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1023048626Medicaid
IAP00469837OtherRR MEDICARE
IA1023048626Medicaid
IA71926003Medicare PIN