Provider Demographics
NPI:1174713051
Name:OCTAVIO CALVILLO M.D.,PH.D.
Entity type:Organization
Organization Name:OCTAVIO CALVILLO M.D.,PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MDPH,D
Authorized Official - Phone:713-979-3190
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:713-979-3190
Mailing Address - Fax:713-979-0132
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:#1612
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-979-3190
Practice Address - Fax:713-979-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6062207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163404001Medicaid
TX8AJ682OtherBCBS GROUP #
TX163404001Medicaid