Healthcare Provider Details

I. General information

NPI: 1770601163
Provider Name (Legal Business Name): STILLPOINT MEDICAL GROUP P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 WORTH ST
HEMPHILL TX
75948-7215
US

IV. Provider business mailing address

PO BOX 1934
SAN ANTONIO TX
78297-1934
US

V. Phone/Fax

Practice location:
  • Phone: 409-787-3772
  • Fax: 409-787-4506
Mailing address:
  • Phone: 818-524-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC3918
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberG6002
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG6002
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG6002
License Number StateTX

VIII. Authorized Official

Name: DR. RAUL G RODRIGUEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-524-8786