Provider Demographics
NPI:1811948607
Name:O'QUINN, JONATHAN CARL (DPM)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CARL
Last Name:O'QUINN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 W ARLINGTON BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0000
Mailing Address - Country:US
Mailing Address - Phone:252-830-1000
Mailing Address - Fax:252-830-0511
Practice Address - Street 1:2140 W ARLINGTON BLVD
Practice Address - Street 2:STE D
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0000
Practice Address - Country:US
Practice Address - Phone:252-830-1000
Practice Address - Fax:252-830-0511
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC483213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890182YMedicaid
NC5900554Medicaid
NC0810YOtherBCBSNC
NC890182YMedicaid
NC2430083AMedicare ID - Type Unspecified
NC2430083BMedicare ID - Type Unspecified
NC5900554Medicaid