Provider Demographics
NPI:1134341225
Name:ROBERT L QUILLIN, MD
Entity type:Organization
Organization Name:ROBERT L QUILLIN, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:QUILLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-646-1935
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 494
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:281-338-5437
Mailing Address - Fax:281-338-9543
Practice Address - Street 1:333 N TEXAS AVE
Practice Address - Street 2:SUITE 4300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4966
Practice Address - Country:US
Practice Address - Phone:281-338-5437
Practice Address - Fax:281-338-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017PCOtherBCBS GROUP ID