Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5079 | AK |
Y | 222Z00000X | Podiatrist | 5079 | AK |
NPI | 1023083870 |
---|---|
Provider Name | Dr. Manx Quayle |
First Address | Fairbanks, AK 99701-7423 |
Second Address | Fairbanks, AK 99701-7423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BQ4123650 | DEA NUMBER (01) | |
PD4324 | (05) | AK |
U52755 | (02) | AK |