Provider Demographics
NPI:1932239076
Name:QUISENBERRY, THOMAS ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERIC
Last Name:QUISENBERRY
Suffix:
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 1:1412 WILLOW AVE APT 69
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1432
Mailing Address - Country:US
Mailing Address - Phone:502-608-3713
Mailing Address - Fax:
Practice Address - Street 1:DEPT. OF INTERNAL MEDICINE, ACB, UNIVERSITY OF LOUISVIL
Practice Address - Street 2:530 SOUTH JACKSON ST
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR-1064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine