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NPI Code Detail

MEDICARE: DR. ROBERT LOUIS QUILLIN MD

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
1208M00000XHospitalist PhysicianK8678TX
2208000000XPediatrics PhysicianK8678TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1K8678OTHERTXMEDICAL 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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Directions to “ DR. ROBERT LOUIS QUILLIN MD” Practice Location

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