Provider Demographics
NPI:1245239342
Name:QUINNEY, BEN H JR (MD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:H
Last Name:QUINNEY
Suffix:JR
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 1:1455 E BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-6000
Mailing Address - Country:US
Mailing Address - Phone:318-798-4500
Mailing Address - Fax:318-798-4601
Practice Address - Street 1:1114 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3028
Practice Address - Country:US
Practice Address - Phone:318-798-4616
Practice Address - Fax:318-798-4619
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2025-09-16
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
LA011157207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1136816Medicaid
LA1136816Medicaid
LA5K956Medicare PIN
LA5DB72Medicare PIN
LAB61132Medicare UPIN