Provider Demographics
NPI:1912973165
Name:TRIFILO, RICHARD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
Last Name:TRIFILO
Suffix:
Gender:M
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:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-8620
Mailing Address - Fax:325-437-8695
Practice Address - Street 1:3449 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4640
Practice Address - Country:US
Practice Address - Phone:325-437-8620
Practice Address - Fax:325-437-8695
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE52434207Q00000X
IL036-0987812083A0100X, 2083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135316101OtherFIRSTCARE/ADC
TX7277870OtherAETNA
TXP00337438OtherMEDICARE RR
TX187706001OtherMEDICAID/ADC
TX8X7153OtherBCBS/ADC
TX8M3001OtherBCBS
TXCR1046OtherMCR RXR
TX135316100OtherFIRSTCARE
TX135316101OtherFIRSTCARE/ADC
TXI56358Medicare UPIN