Provider Demographics
NPI:1558310219
Name:HORRILLENO, HENRY T (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:T
Last Name:HORRILLENO
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 1:4700 DEXTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5299
Mailing Address - Country:US
Mailing Address - Phone:469-209-8100
Mailing Address - Fax:469-209-8101
Practice Address - Street 1:4700 DEXTER DR STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5299
Practice Address - Country:US
Practice Address - Phone:469-209-8100
Practice Address - Fax:469-209-8101
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25632208600000X
TXG10422086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200115770AMedicaid
F24712Medicare UPIN
OK249723705Medicare PIN