Provider Demographics
NPI:1720088875
Name:TRILLOS, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:TRILLOS
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 1:13111 EAST FWY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5820
Mailing Address - Country:US
Mailing Address - Phone:713-455-6070
Mailing Address - Fax:713-455-6466
Practice Address - Street 1:13111 EAST FWY
Practice Address - Street 2:SUITE 217
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5803
Practice Address - Country:US
Practice Address - Phone:713-455-6070
Practice Address - Fax:713-455-6466
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5968207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0685407OtherAETNA PROVIDER NUMBER
TX132004604Medicaid
TXB27078Medicare UPIN
TX0685407OtherAETNA PROVIDER NUMBER