Basic Information
| Provider Information | |||||||||
| NPI: | 1326024654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLMAN | ||||||||
| FirstName: | CYRIL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 200993 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772160993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817841111 | ||||||||
| FaxNumber: | 2817841555 | ||||||||
| Practice Location | |||||||||
| Address1: | 13111 EAST FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770155820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133932000 | ||||||||
| FaxNumber: | 7133932714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 03/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L8700 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 168727901 | 05 | TX | MEDICAID | 1326024654 | 01 | TX | BCBSTX | OTHER | 8G4117 | 01 | TX | BCBSTX PROV NO | OTHER | 1326024654 | 01 | TX | TRICARE SOUTH | OTHER |