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NPI Code Detail

MEDICARE: DR. NATE D QUILICI M.D.

MEDICARE: DR. NATE D QUILICI M.D.
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
1174400000XSpecialist7798OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326041526
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATE D QUILICI M.D.
Provider Business Mailing Address
First Line : 9400 SW BARNES RD
Second Line : SUITE 307
City : PORTLAND
State : OR
Zip : 97225-6608
Country : US
Telephone Number : 503-292-9108
Fax Number : 503-292-0346
Provider Business Practice Location Address
First Line : 9205 SW BARNES RD
Second Line :
City : PORTLAND
State : OR
Zip : 97225-6603
Country : US
Telephone Number : 503-216-2181
Fax Number : 503-216-4850
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/16/2007

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