Provider Demographics
NPI:1437362266
Name:QUILON, AUGUSTO MAYOR III (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:MAYOR
Last Name:QUILON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:14810 OLD SAINT AUGUSTINE RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2558
Practice Address - Country:US
Practice Address - Phone:904-292-4111
Practice Address - Fax:904-292-4080
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107388207RR0500X, 207RR0500X
PAMT183642207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0024358-00Medicaid
FLP00871767OtherRAILROAD MEDICARE
FLP00871767OtherRAILROAD MEDICARE