Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1621 | TX |
NPI | 1174703425 |
---|---|
Provider Name | Anastasios Sotiropoulos |
First Address | Dallas, TX 75238-0561 |
Second Address | Dallas, TX 75240-5789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2007 |
Last Update Date | 03/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00393Y | MEDICARE GROUP ID (01) | TX |
0053JB | BLUE CROSS BLUE SHIELD (01) | TX |
1621 | MEDICAL LICENSE (01) | TX |
P00217354 | MEDICARE RAILROAD (01) | |
U76007 | (02) | TX |