Provider Demographics
NPI:1114917572
Name:FOTINOS, MELETIOS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MELETIOS
Middle Name:JAMES
Last Name:FOTINOS
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 1:415 EMBASSY OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2040
Mailing Address - Country:US
Mailing Address - Phone:210-490-9087
Mailing Address - Fax:210-490-9111
Practice Address - Street 1:415 EMBASSY OAKS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2040
Practice Address - Country:US
Practice Address - Phone:210-490-9087
Practice Address - Fax:210-490-9111
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360250001Medicaid