Individual
DR. JACK B QUIGLEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1020 N SAN FRANCISCO ST, # 200, FLAGSTAFF, AZ 86001-3281
(928) 774-2300
(928) 214-2150
Mailing address
1020 N SAN FRANCISCO ST, # 200, FLAGSTAFF, AZ 86001-3281
(928) 774-2300
(928) 214-2150
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
20243
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054768
—
AZ
01
—
18032746
STATE COMP AZ
AZ
01
—
2004440
CIGNA
AZ
01
—
20243
AZ LICENSE
AZ
01
—
8607474153000
TAX ID
AZ
01
—
AZ0355110
BLUE CROSS BLUE SHIELD AZ
AZ
05
—
P054768
—
AZ
Enumeration date
05/31/2005
Last updated
07/09/2007
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