Provider Demographics
NPI:1740883057
Name:QUINTON, JERRY ALLEN
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:ALLEN
Last Name:QUINTON
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 1:3901 W TOLEDO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6148
Mailing Address - Country:US
Mailing Address - Phone:918-852-6983
Mailing Address - Fax:
Practice Address - Street 1:3901 W TOLEDO ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6148
Practice Address - Country:US
Practice Address - Phone:918-852-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer