Provider Demographics
NPI:1194168336
Name:QUILES, WENDY R (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:R
Last Name:QUILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1707 COLE BLVD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80228
Mailing Address - Country:US
Mailing Address - Phone:303-233-8295
Mailing Address - Fax:
Practice Address - Street 1:1707 COLE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3255
Practice Address - Country:US
Practice Address - Phone:303-233-8443
Practice Address - Fax:303-233-8295
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0060643207Q00000X
FLME129541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019093200Medicaid
WA08071978OtherDOB
FLIT438ZMedicare PIN