Provider Demographics
NPI:1265559595
Name:MCQUILKIN, SHAWN DAVID (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:DAVID
Last Name:MCQUILKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1541 WASATCH DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1422
Mailing Address - Country:US
Mailing Address - Phone:801-475-5017
Mailing Address - Fax:801-475-5017
Practice Address - Street 1:WSU STUDENT HEALTH CENTER
Practice Address - Street 2:1128 UNIVERSITY CIRCLE
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-1128
Practice Address - Country:US
Practice Address - Phone:801-626-6459
Practice Address - Fax:801-626-7786
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176177-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000001352OtherPIN OGDEN
UT176177 1205OtherSTATE LICENSE NUMBER
UT176177 1205OtherSTATE LICENSE NUMBER