Individual
DEOGRACIA QUINONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
WOMACK ARMY MEDICAL CTR, STOP A, 2817 REILLY ROAD, FORT BRAGG, NC 28310-0001
(910) 907-8664
(910) 907-7762
Mailing address
WOMACK ARMY MEDICAL CTR, STOP A, 2817 REILLY ROAD, FORT BRAGG, NC 28310-0001
(910) 907-8664
(910) 907-7762
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35729
NC
208800000X
Urology Physician
35729
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89131WR
—
NC
Enumeration date
08/09/2005
Last updated
07/09/2010
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