Provider Demographics
NPI:1376703108
Name:BILHARTZ, PAUL DAVID ROCKY (MD, MBA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID ROCKY
Last Name:BILHARTZ
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:ROCKY
Other - Middle Name:D
Other - Last Name:BILHARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:1721 BIRMINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4082
Mailing Address - Country:US
Mailing Address - Phone:979-695-9540
Mailing Address - Fax:979-764-9249
Practice Address - Street 1:1721 BIRMINGHAM DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4082
Practice Address - Country:US
Practice Address - Phone:979-695-9540
Practice Address - Fax:979-764-9249
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5636174400000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CT893OtherBCBS