Provider Demographics
NPI:1134484975
Name:SOTELLO AVILES, DAVID AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:AUGUSTO
Last Name:SOTELLO AVILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:525 BRANSON LANDING BLVD STE 306
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2140
Practice Address - Country:US
Practice Address - Phone:417-335-7559
Practice Address - Fax:417-348-8429
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020008344207RP1001X
TXBP20059616390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease