Provider Demographics
NPI:1952391179
Name:LAW, QUINTIN ORVILLE (MD)
Entity Type:Individual
Prefix:
First Name:QUINTIN
Middle Name:ORVILLE
Last Name:LAW
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 1:208 NAVARRE ST
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4130
Mailing Address - Country:US
Mailing Address - Phone:850-982-3456
Mailing Address - Fax:850-932-8697
Practice Address - Street 1:204 CENTER ST
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4392
Practice Address - Country:US
Practice Address - Phone:850-932-3456
Practice Address - Fax:850-932-8697
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379277300Medicaid
FLK4373Medicare UPIN
FLK4373Medicare PIN