Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | ME54991 | FL |
Y | 207VX0000X | Obstetrician | ME54991 | FL |
NPI | 1417059106 |
---|---|
Provider Name | Dr. Manuel R Quintana |
First Address | Winter Park, FL 32789-2127 |
Second Address | Orlando, FL 32803-1248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 01/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035642500 | (05) | FL |
08920 | BC/BS (01) | FL |
3872911 | CIGNA (01) | FL |