MEDICARE: DR. MELETIOS JAMES FOTINOS M.D.

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
1	207Q00000X	Family Medicine Physician	Q8245	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1114917572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELETIOS JAMES FOTINOS M.D.

Provider Business Mailing Address
First Line	:	415 EMBASSY OAKS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2040
Country	:	US
Telephone Number	:	210-490-9087
Fax Number	:	210-490-9111

Provider Business Practice Location Address
First Line	:	415 EMBASSY OAKS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2040
Country	:	US
Telephone Number	:	210-490-9087
Fax Number	:	210-490-9111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	02/16/2018

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