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NPI Code Detail

MEDICARE: RODRIGO WILLIAM SOTILLO MD

MEDICARE:   RODRIGO WILLIAM SOTILLO  MD
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
1207R00000XInternal Medicine PhysicianJ5488TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38X0056OTHERTXBCBS

General Provider Information

NPI Number : 1861424319
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODRIGO WILLIAM SOTILLO MD
Provider Business Mailing Address
First Line : PO BOX 632040
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75963-2040
Country : US
Telephone Number : 936-560-5668
Fax Number :
Provider Business Practice Location Address
First Line : 1309 S UNIVERSITY DR
Second Line :
City : NACOGDOCHES
State : TX
Zip : 75961-6486
Country : US
Telephone Number : 936-560-5668
Fax Number : 214-645-8601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 04/02/2024

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