Provider Demographics
NPI:1750391264
Name:QUILLIN, ELIZABETH P (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:P
Last Name:QUILLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:P
Other - Last Name:QUILLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:909 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-342-4660
Mailing Address - Fax:541-344-5127
Practice Address - Street 1:909 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-342-4660
Practice Address - Fax:541-344-5127
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65078Medicare UPIN
ORR130893Medicare PIN