Provider Demographics
NPI:1730180910
Name:QUATTROCCHI, KEITH BRADLEY (MD, PHD, FACS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BRADLEY
Last Name:QUATTROCCHI
Suffix:
Gender:M
Credentials:MD, PHD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 B ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4653
Mailing Address - Country:US
Mailing Address - Phone:530-401-0643
Mailing Address - Fax:
Practice Address - Street 1:140 B ST
Practice Address - Street 2:SUITE 5
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4653
Practice Address - Country:US
Practice Address - Phone:530-401-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58571207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G585710Medicare PIN