Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1849-79 | MS |
N | 204E00000X | Oral & Maxillofacial Surgeon | 1849-79 | MS |
NPI | 1275536252 |
---|---|
Provider Name | Dr. Daniel Quon |
First Address | Jackson, MS 39211-2667 |
Second Address | Jackson, MS 39211-2667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 06/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T20884 | (02) |