DR. RAUL M PORTILLO (NPI# 1265473391) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265473391 |
| Entity Type | Individual |
| Full Name | DR. RAUL M PORTILLO |
| Credential | MD |
| Practice Address |
1200 Brooklyn Ave Ste 115 San Antonio TX 78212-4815 |
| Mailing Address |
Po Box 911230 Dallas TX 75391-1230 |
| Practice Telephone | 2102246531 |
| Practice Fax Number | 2102260402 |
| Mailing Telephone | 9729978000 |
| Mailing Fax Number | 9724379605 |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2018-03-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
G4193 | TX | Allopathic & Osteopathic Physicians |
| N | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
G4193 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 000V5772 | 05 | |
| TX | 123759602 | 05 | |
| TX | 177173501 | 05 | |
| TX | BLUE CROSS OF TEXAS | 8R1527 | 01 |
| TX | 123759601 | 05 |
| Street Address |
1200 BROOKLYN AVE STE 115 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78212-4815 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902451701 | Ninfa Hernandez Guzman | Assisted Living Facility | 325 E Locust St., San Antonio, TX 78212 | 2019-08-08 |
| 1366924730 | David Edward Dupuy | Occupational Therapist | 307 West Cypress, San Antonio, TX 78212 | 2018-09-03 |
| 1184100836 | Magenta Health, Inc. | Clinic/Center | 1222 North Main, Suite 115, San Antonio, TX 78212 | 2018-07-16 |
| 1497275762 | Dms Pharmacy, LLC | Pharmacy | 305 East Euclid, Suite 104, San Antonio, TX 78212 | 2017-06-27 |
| 1245693290 | Rebecca Lynn Sherman | Physical Therapist | 40 Ne Interstate 410 Loop, San Antonio, TX 78212 | 2016-03-29 |
| 1669886032 | Felise De Novo, PC | Counselor | 2400 Mccullough Ave., #12851, San Antonio, TX 78212 | 2014-06-13 |
| 1699102699 | Prem S. Kalidindi | Pharmacist | 2608 N. Main, Ste 1, San Antonio, TX 78212 | 2013-10-04 |
| 1073860052 | Sarah Nicole Percy Tovar | Dentist | 4118 Mccullough Ave., Suite 6, San Antonio, TX 78212 | 2012-08-09 |
| 1205181674 | Michael Jose Cavazos | Internal Medicine | 1100 Mccullough Ave Ste 300, San Antonio, TX 78212 | 2012-07-20 |
| 1730458381 | Neuriom, Pllc | Electrodiagnostic Medicine | 4007 Mccullough Ave, #243, San Antonio, TX 78212 | 2011-12-27 |
| Find all providers in zip 78212 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881965481 | Spurs Lane Medical Associates Pa | Internal Medicine | 2 Spurs Lane, Bldg 6 Ste 100, San Antonio, TX 78240-1634 | 2012-01-13 |
| 1942486964 | Cancer Care Network of South Texas Pa | Internal Medicine | 2130 N.e. Loop 410, Suite #100, San Antonio, TX 78217-4660 | 2008-01-22 |
| 1457547135 | Ju-hsien Chao | Internal Medicine | 4450 Medical Dr Fl 1, San Antonio, TX 78229-3710 | 2007-09-17 |
| 1558403337 | Slavisa Gasic | Internal Medicine | 7355 Barlite Blvd Ste 504, San Antonio, TX 78224-1341 | 2007-02-12 |
| 1700980299 | Alexei Arkhipov | Internal Medicine | 7390 Barlite Blvd, Suite 205, San Antonio, TX 78224-1337 | 2006-09-12 |
| 1457374142 | Stephen C Cohen | Internal Medicine | 2130 N.e.loop 410, Suite #250, San Antonio, TX 78217-4660 | 2006-07-25 |
| 1285662510 | Jayasree N Rao | Internal Medicine | 202 Baltimore, San Antonio, TX 78215-1907 | 2006-06-28 |
| 1881632974 | Zulfaqqar M Jaffar | Internal Medicine | 8019 S New Braunfels Ste 101, San Antonio, TX 78235-1069 | 2006-06-02 |
| 1336120054 | Cancer Care Centers of South Texas | Internal Medicine | 4411 Medical Dr, Ste. 100, San Antonio, TX 78229-3832 | 2005-11-09 |
| 1376546861 | Kyriakos Peter Papadopoulos | Internal Medicine | 4383 Medical Dr, San Antonio, TX 78229-3307 | 2005-05-27 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78212 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.