Provider Demographics
NPI:1124060546
Name:CIMO, PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:CIMO
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:925 GESSNER RD
Practice Address - Street 2:SUITE 550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2545
Practice Address - Country:US
Practice Address - Phone:713-467-1722
Practice Address - Fax:713-467-1704
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4070207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119040704Medicaid
TX119040702Medicaid
TX119040705Medicaid
TX119040701Medicaid
830002244OtherRAILROAD
TX8R1411OtherBLUE CROSS OF TEXAS
TX119040705Medicaid
TX87X858Medicare PIN
TX87751KMedicare PIN
830002244OtherRAILROAD