Provider Demographics
NPI:1063422384
Name:HILTON, GARY J (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:HILTON
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 1:2701 S GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1930
Mailing Address - Country:US
Mailing Address - Phone:806-350-3000
Mailing Address - Fax:806-350-3337
Practice Address - Street 1:2701 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1930
Practice Address - Country:US
Practice Address - Phone:806-350-3000
Practice Address - Fax:806-350-3337
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH108A8197OtherDME
TX115143100OtherFIRST CARE
TX8A8197OtherBCBS
TX114007104Medicaid
TXH108A8197OtherDME
TXC16943Medicare UPIN
8529MOMedicare PIN
TX115143100OtherFIRST CARE
TX8A8197OtherBCBS