Provider Demographics
NPI:1104013499
Name:MURILLO, CARLOS ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ANDRES
Last Name:MURILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-1019
Mailing Address - Country:US
Mailing Address - Phone:832-582-8114
Mailing Address - Fax:832-830-8927
Practice Address - Street 1:7400 FANNIN ST STE 870
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1935
Practice Address - Country:US
Practice Address - Phone:832-582-8114
Practice Address - Fax:832-830-8927
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6787208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB159654Medicare PIN