Individual
MR. MALCOLM RANDALL QUATTLEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3090 FM 317, ATHENS, TX 75752-5796
(903) 675-5900
(903) 675-5900
Mailing address
3090 FM 317, ATHENS, TX 75752-5796
(903) 675-5900
(903) 675-5900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0079342
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
507686
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/21/2007
Last updated
01/20/2009
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