MEDICARE: HENRY T HORRILLENO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	25632	OK
2	2086S0129X	Vascular Surgery Physician	G1042	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558310219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY T HORRILLENO MD

Provider Business Mailing Address
First Line	:	4700 DEXTER DR STE 400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5299
Country	:	US
Telephone Number	:	469-209-8100
Fax Number	:	469-209-8101

Provider Business Practice Location Address
First Line	:	4700 DEXTER DR STE 400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5299
Country	:	US
Telephone Number	:	469-209-8100
Fax Number	:	469-209-8101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	09/17/2020

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