Provider Demographics
NPI:1427065341
Name:EMERSON, QUENTIN B (MD)
Entity type:Individual
Prefix:DR
First Name:QUENTIN
Middle Name:B
Last Name:EMERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:FORT BRANCH
Mailing Address - State:IN
Mailing Address - Zip Code:47648-0185
Mailing Address - Country:US
Mailing Address - Phone:812-753-4181
Mailing Address - Fax:812-753-4399
Practice Address - Street 1:7861 S PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648-8405
Practice Address - Country:US
Practice Address - Phone:812-753-4181
Practice Address - Fax:812-753-4399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100122120Medicaid
INB28694Medicare UPIN