Provider Demographics
NPI:1154320935
Name:SPILLER, PAUL CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:CRAIG
Last Name:SPILLER
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 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:1507 RIVERY BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3058
Practice Address - Country:US
Practice Address - Phone:512-509-9550
Practice Address - Fax:512-509-9555
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040557207Q00000X
SC22040207Q00000X
TXQ7483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC220406Medicaid
SCGP4210Medicaid
GA000672229FMedicaid
SC202660098OtherGAFFNEY HMA PHYSICIAN MANAGEMENT
GAF71245Medicare UPIN
GA000672229FMedicaid
GA08BBQWJMedicare PIN
SCAA19438186Medicare PIN
SCAA1943Medicare UPIN
SC220406Medicaid