Provider Demographics
NPI:1962462838
Name:QUIGLEY, RICHARD CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 JAMES COLEMAN DR STE C
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3111
Mailing Address - Country:US
Mailing Address - Phone:361-576-2222
Mailing Address - Fax:361-579-4925
Practice Address - Street 1:202 JAMES COLEMAN DRIVE, SUITE C
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904
Practice Address - Country:US
Practice Address - Phone:361-576-2222
Practice Address - Fax:361-579-4925
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ763450Medicaid
TX8X8931OtherBLUE CROSS
TX8U9126OtherBLUECROSSBLUE SHIELD, DETAR
AZBQ7699979OtherDEA
TX8L6469Medicare PIN
AZ84502Medicare ID - Type UnspecifiedMEDICARE ID
TX8U9126OtherBLUECROSSBLUE SHIELD, DETAR
AZ763450Medicaid