Provider Demographics
NPI:1558320440
Name:FILLMAN, ROBERT (PA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:FILLMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 OLD HAMMOND HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8264
Mailing Address - Country:US
Mailing Address - Phone:225-923-0960
Mailing Address - Fax:225-923-3736
Practice Address - Street 1:10423 OLD HAMMOND HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8264
Practice Address - Country:US
Practice Address - Phone:225-923-0960
Practice Address - Fax:225-923-3736
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10111.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508969Medicaid
LA1179345Medicaid
LA5DE56PF14Medicare PIN
LA5DL13PC80Medicare PIN
LAS18032Medicare UPIN
LA5J290P123Medicare ID - Type Unspecified
LA1508969Medicaid