Healthcare Provider Details

I. General information

NPI: 1134484975
Provider Name (Legal Business Name): DAVID AUGUSTO SOTELLO AVILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E REPUBLIC RD
SPRINGFIELD MO
65804-4623
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 806-620-9990
  • Fax:
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2020008344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: