Provider Demographics
NPI:1578586038
Name:AGUILAR, PHILLIP MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MARK
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1507
Mailing Address - Country:US
Mailing Address - Phone:713-461-2915
Mailing Address - Fax:713-461-5307
Practice Address - Street 1:302 HIGHWAY 3 S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3755
Practice Address - Country:US
Practice Address - Phone:713-461-2915
Practice Address - Fax:713-461-2915
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130891808Medicaid
TX0026JUOtherBCBS
TX8FT532OtherBLUE CROSS BLUE SHIELD
TX8FP965OtherBLUE CROSS BLUE SHIELD
TX8A5577Medicare PIN
TX465055YMVQMedicare PIN
TX465055ZSWDMedicare PIN
TX130891808Medicaid