MEDICARE: DR. ROBERT LOUIS QUILLIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	K8678	TX
2	208000000X	Pediatrics Physician	K8678	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K8678	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1144227257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LOUIS QUILLIN MD

Provider Business Mailing Address
First Line	:	1325 PENNSYLVANIA AVE STE 740
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2144
Country	:	US
Telephone Number	:	817-250-5435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2122
Country	:	US
Telephone Number	:	817-250-5435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	12/06/2018

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