Provider Demographics
NPI:1811086051
Name:KILLYON, GARRY W (MD, DDS)
Entity type:Individual
Prefix:
First Name:GARRY
Middle Name:W
Last Name:KILLYON
Suffix:
Gender:M
Credentials:MD, DDS
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 STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5819
Mailing Address - Country:US
Mailing Address - Phone:713-453-7186
Mailing Address - Fax:713-453-3003
Practice Address - Street 1:13111 EAST FWY STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5819
Practice Address - Country:US
Practice Address - Phone:713-453-7186
Practice Address - Fax:713-453-3003
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033141501Medicaid
TX033141501Medicaid
TXG63630Medicare UPIN