Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | J1917 | TX |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | J1917 | TX |
NPI | 1598709305 |
---|---|
Provider Name | Dr. Mark M Casillas |
First Address | San Antonio, TX 78258-4349 |
Second Address | San Antonio, TX 78258-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048005502 | (05) | TX |
1676698 | CIGNA (01) | TX |
5972563 | AETNA (01) | TX |
8K6270 | BCBS (01) | TX |
P00088532 | RAILROAD MEDICARE (01) | TX |