Provider Demographics
NPI:1659355691
Name:HILLIARD, DENNIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:HILLIARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E HIGHLAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3834
Mailing Address - Country:US
Mailing Address - Phone:909-886-6806
Mailing Address - Fax:909-883-8132
Practice Address - Street 1:401 E HIGHLAND AVE
Practice Address - Street 2:C
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3803
Practice Address - Country:US
Practice Address - Phone:909-886-6806
Practice Address - Fax:909-883-8132
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33679207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110082001OtherRAILROAD MEDICARE
CA00G336790Medicaid
CA00G336790Medicare PIN