Provider Demographics
NPI:1184640336
Name:OQUINN, BANCROFT JR (MD)
Entity type:Individual
Prefix:DR
First Name:BANCROFT
Middle Name:
Last Name:OQUINN
Suffix:JR
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 1:1405 BADDOUR PARKWAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:615-444-6500
Mailing Address - Fax:615-449-1306
Practice Address - Street 1:1405 WEST BADDOUR PARKWAY
Practice Address - Street 2:SUITE 106
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-444-6500
Practice Address - Fax:615-449-1306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18417207Y00000X
TNMD0000018417207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
73029OtherBLUUE CROSS
TN3029464Medicaid
4066065OtherAETNA
73029OtherBLUUE CROSS
A99339Medicare UPIN