Provider Demographics
NPI:1861424319
Name:SOTILLO, RODRIGO WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:WILLIAM
Last Name:SOTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632040
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2040
Mailing Address - Country:US
Mailing Address - Phone:936-560-5668
Mailing Address - Fax:
Practice Address - Street 1:1309 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-6486
Practice Address - Country:US
Practice Address - Phone:936-560-5668
Practice Address - Fax:214-645-8601
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138898513Medicaid
TX1388985-14Medicaid
TX8X0056OtherBCBS
TX1388985-14Medicaid
TXP00439000Medicare PIN
TX8B4669Medicare PIN
TX138898513Medicaid