Provider Demographics
NPI:1750593356
Name:TILLIS, ALAN C (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:C
Last Name:TILLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 OSKAR CT
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-8236
Mailing Address - Country:US
Mailing Address - Phone:973-992-0538
Mailing Address - Fax:973-992-1333
Practice Address - Street 1:1 OSKAR CT
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-8236
Practice Address - Country:US
Practice Address - Phone:973-992-0538
Practice Address - Fax:973-992-1333
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02117500207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58365Medicare UPIN