Provider Demographics
NPI:1477566644
Name:MURILLO, RICARDO ALONSO (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:ALONSO
Last Name:MURILLO
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 1:3600 GASTON AVE
Mailing Address - Street 2:BARNETT TOWER, SUITE 708
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-827-6200
Mailing Address - Fax:214-827-8480
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:BARNETT TOWER, SUITE 708
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-827-6200
Practice Address - Fax:214-827-8480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG34865Medicare UPIN
TX8643N0Medicare ID - Type Unspecified