Provider Demographics
NPI:1609076959
Name:QUIGLEY, LAJOHN B (MD)
Entity type:Individual
Prefix:
First Name:LAJOHN
Middle Name:B
Last Name:QUIGLEY
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 1:1400 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1708
Mailing Address - Country:US
Mailing Address - Phone:806-414-9558
Mailing Address - Fax:806-354-5693
Practice Address - Street 1:1400 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9558
Practice Address - Fax:806-354-5693
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44736208600000X
TXBP1-0027863208600000X, 390200000X
TXQ6687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70526257Medicaid
TX339945302Medicaid
OK200558040 AMedicaid
TX339945301Medicaid
TX369052YP72Medicare PIN