Provider Demographics
NPI:1902887532
Name:HILLER, FREDERICK E (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:E
Last Name:HILLER
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 1:6200 REGIONAL PLZ
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5250
Mailing Address - Country:US
Mailing Address - Phone:325-690-1805
Mailing Address - Fax:325-690-6145
Practice Address - Street 1:6200 REGIONAL PLZ
Practice Address - Street 2:SUITE 1200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5250
Practice Address - Country:US
Practice Address - Phone:325-690-1805
Practice Address - Fax:325-690-6145
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1646207RN0300X
GA071186207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139042915Medicaid
TXE21776Medicare UPIN
TX8233K3Medicare ID - Type UnspecifiedMEDICARE