Provider Demographics
NPI:1710724992
Name:MCBRIDE, QUINN STEPHEN
Entity type:Individual
Prefix:
First Name:QUINN
Middle Name:STEPHEN
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 E SOUTH CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4488
Mailing Address - Country:US
Mailing Address - Phone:812-322-5831
Mailing Address - Fax:
Practice Address - Street 1:3704 E SOUTH CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4488
Practice Address - Country:US
Practice Address - Phone:812-322-5831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program