Provider Demographics
NPI:1235126319
Name:DE LA COTERA JULE, RODRIGO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:
Last Name:DE LA COTERA JULE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODRIGO
Other - Middle Name:
Other - Last Name:DELACOTERA JULE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:129 VISION PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3024
Mailing Address - Country:US
Mailing Address - Phone:281-248-8872
Mailing Address - Fax:281-248-8875
Practice Address - Street 1:129 VISION PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3024
Practice Address - Country:US
Practice Address - Phone:281-248-8872
Practice Address - Fax:281-248-8875
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178643601Medicaid
TX178643601Medicaid
TXI40791Medicare UPIN