Provider Demographics
NPI:1811990088
Name:MCQUILLIN, PAMELA A (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:MCQUILLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 E 8TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4733
Mailing Address - Country:US
Mailing Address - Phone:432-580-9191
Mailing Address - Fax:949-862-7691
Practice Address - Street 1:1330 E 8TH ST STE 420
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4733
Practice Address - Country:US
Practice Address - Phone:432-580-9191
Practice Address - Fax:949-862-7691
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0075JEOtherBLUE CROSS BLUE SHIELD
TX150797201Medicaid
TX131487101OtherFIRSTCARE
TX0075JEOtherBLUE CROSS BLUE SHIELD
TX131487101OtherFIRSTCARE