Individual
JOHN M IAQUINTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 MEDICAL PARK, STE. 330, COLUMBIA, SC 29203
(803) 296-7305
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2005010201
MO
207XX0801X
Orthopaedic Trauma Physician
2005010201
MO
207XX0801X
Orthopaedic Trauma Physician
Primary
30693
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-0838370
COVENTRY
MO
05
—
200326830A
—
KS
05
—
200326830B
—
KS
05
—
207429408
—
MO
05
—
306939
—
SC
01
—
35477015
BCBS(PHP) RMC LOCATION
MO
01
—
35477025
BCBS(PHP) MIDWEST TRAUMA
MO
01
—
4403943
AETNA
MO
01
—
56779
HEALTHCARE USA-MIDWEST LO
MO
01
—
76-0726650
HUMANA
MO
01
—
925760
FIRST GUARD-RMC LOCATION
MO
Enumeration date
06/12/2006
Last updated
06/04/2020
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