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NPI Code Detail

MEDICARE: STILLPOINT MEDICAL GROUP P.A.

MEDICARE: STILLPOINT MEDICAL GROUP P.A.
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
1207Q00000XFamily Medicine PhysicianC3918TX
22084A0401XAddiction Medicine (Psychiatry & Neurology) PhysicianG6002TX
32084P0802XAddiction Psychiatry PhysicianG6002TX
42084P0800XPsychiatry PhysicianG6002TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2G6002OTHERTXTEXAS MEDICAL LICENSE

General Provider Information

NPI Number : 1770601163
Entity Type Code : Organization
Provider Name (Legal Business Name) : STILLPOINT MEDICAL GROUP P.A.
Provider Business Mailing Address
First Line : PO BOX 1934
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78297-1934
Country : US
Telephone Number : 818-524-8786
Fax Number :
Provider Business Practice Location Address
First Line : 2421 WORTH ST
Second Line :
City : HEMPHILL
State : TX
Zip : 75948-7215
Country : US
Telephone Number : 409-787-3772
Fax Number : 409-787-4506
Authorized Official
Title or Position : PRESIDENT
Name : DR. RAUL G RODRIGUEZ
Credential : M.D.
Telephone Number : 818-524-8786
Provider Enumeration Date : 03/26/2007
Last Update Date : 11/17/2010

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Directions to “STILLPOINT MEDICAL GROUP P.A. ” Practice Location

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