Individual
JEFFERSON QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 HENRY ST, NORTH VERNON, IN 47265-1030
(317) 695-1241
Mailing address
4207 N 500 W, BARGERSVILLE, IN 46106-9251
(317) 695-1241
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01037759A
IN
207Q00000X
Family Medicine Physician
01037759
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100194060
—
IN
Enumeration date
11/01/2006
Last updated
03/10/2022
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