Provider Demographics
NPI:1922098417
Name:QUIGLEY, ROBERT L (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:QUIGLEY
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 1:133 BENMORE DRIVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4143
Mailing Address - Country:US
Mailing Address - Phone:407-646-7070
Mailing Address - Fax:407-646-7747
Practice Address - Street 1:133 BENMORE DRIVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4143
Practice Address - Country:US
Practice Address - Phone:407-646-7070
Practice Address - Fax:407-646-7747
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039305300Medicaid
47329YMedicare ID - Type Unspecified
FL039305300Medicaid