Healthcare Provider Details

I. General information

NPI: 1245224104
Provider Name (Legal Business Name): ROY H GILLICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 MASON RD A4
KATY TX
77450-3896
US

IV. Provider business mailing address

830 MASON RD A4
KATY TX
77450-3896
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-2222
  • Fax: 281-392-4861
Mailing address:
  • Phone: 281-392-2222
  • Fax: 281-392-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE7950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: