Individual
MAURA L GILLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030
(713) 792-6161
Mailing address
P O BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R1030
TX
207RX0202X
Medical Oncology Physician
35.092978
OH
207RX0202X
Medical Oncology Physician
Primary
R1030
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2934016
—
OH
05
—
367423601
—
TX
01
—
8GQ442
BCBS
TX
Enumeration date
05/20/2006
Last updated
10/25/2021
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