Provider Demographics
NPI:1770521387
Name:TRILLO, GERARDO HERNANDEZ (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:HERNANDEZ
Last Name:TRILLO
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-987-1975
Practice Address - Fax:972-335-0712
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8875207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1571OtherBLUE CROSS OF TEXAS
TX134651202Medicaid
TX134651211Medicaid
OK100041920AMedicaid
TX134651213Medicaid
TX8R1571OtherBLUE CROSS OF TEXAS
TX134651202Medicaid
TX8B2845Medicare PIN
TX88127KMedicare PIN
TXTXB126726Medicare PIN