Provider Demographics
NPI:1326024654
Name:GILLMAN, CYRIL E (MD)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:E
Last Name:GILLMAN
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 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:13111 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5820
Practice Address - Country:US
Practice Address - Phone:713-393-2000
Practice Address - Fax:713-393-2714
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168727901Medicaid
TX1326024654OtherBCBSTX
TX8G4117OtherBCBSTX PROV NO
TX1326024654OtherTRICARE SOUTH
TX8G4117OtherBCBSTX PROV NO
TX168727901Medicaid
TX1326024654OtherTRICARE SOUTH
TX1326024654OtherBCBSTX