MEDICARE: DR. RUDYARD LANCE HILLIARD 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	207Q00000X	Family Medicine Physician	BH9505186	TX
2	207P00000X	Emergency Medicine Physician	M2646	TX

General Provider Information

NPI Number	:	1407830979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUDYARD LANCE HILLIARD MD

Provider Business Mailing Address
First Line	:	1223 STETSON GRN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7287
Country	:	US
Telephone Number	:	361-739-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 STETSON GRN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7287
Country	:	US
Telephone Number	:	361-739-1515
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	12/20/2011

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