Provider Demographics
NPI:1831131572
Name:CALVILLO, OCTAVIO J (MD)
Entity Type:Individual
Prefix:
First Name:OCTAVIO
Middle Name:J
Last Name:CALVILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 37
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:713-554-0980
Mailing Address - Fax:713-554-0987
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:1115
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:713-554-0980
Practice Address - Fax:713-554-0987
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG6062207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L33YOtherBCBS
TX8A5605Medicare PIN