Provider Demographics
NPI:1679572499
Name:QUINBY, JONATHAN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:QUINBY
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 1:2 LONDON CT
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6865
Mailing Address - Country:US
Mailing Address - Phone:469-243-9390
Mailing Address - Fax:
Practice Address - Street 1:17051 DALLAS PKWY STE 400
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7108
Practice Address - Country:US
Practice Address - Phone:469-243-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1300207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BR112OtherBCBS
TXM1300OtherMEDICAL LICENSE
TX187180802Medicaid
TXI39070Medicare UPIN
TX187180802Medicaid
TX386766YNJCMedicare PIN
TXM1300OtherMEDICAL LICENSE
TX8L2775Medicare PIN