Healthcare Provider Details

I. General information

NPI: 1174703425
Provider Name (Legal Business Name): ANASTASIOS SOTIROPOULOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2007
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13021 COIT RD SUITE 200
DALLAS TX
75240-5789
US

IV. Provider business mailing address

PO BOX 38561
DALLAS TX
75238-0561
US

V. Phone/Fax

Practice location:
  • Phone: 469-223-0606
  • Fax:
Mailing address:
  • Phone: 469-223-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1621
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: