Provider Demographics
NPI:1184721482
Name:QUINLAN, GREGORY H (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:H
Last Name:QUINLAN
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 1:916 HWY 69
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701
Mailing Address - Country:US
Mailing Address - Phone:620-223-0200
Mailing Address - Fax:620-224-3029
Practice Address - Street 1:916 HWY 69
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701
Practice Address - Country:US
Practice Address - Phone:620-223-0200
Practice Address - Fax:620-224-3029
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-18693207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100230230EMedicaid
P00471637OtherRR MEDICARE
MO242009835Medicaid
KS106984OtherBLUE CROSS BLUE SHIELD
MO242009835Medicaid
KS106984Medicare PIN