Provider Information for 1790382208
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Mr. AARON SAMUEL QUANN
Sex: Male
NPI: 1790382208
Last Updated: 2020-10-07
Certification Date: 2020-10-02
Certification Date: 2020-10-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1790382208 | ||||||||
| Enumeration Date | 2020-10-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2704 REW CIR # 105F OCOEE, FL 34761-2994 United States Phone: 407-573-1192 | Fax: | ||||||||
| Primary Practice Address | 2704 REW CIR # 105F OCOEE, FL 34761-2994 United States Phone: 407-573-1192 | Fax: | ||||||||
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