Provider Demographics
NPI:1497756449
Name:SOTO, JOSE RAUL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAUL
Last Name:SOTO
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 1:909 FROSTWOOD DR STE 1.100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:713-338-5500
Practice Address - Street 1:7737 SOUTHWEST FWY STE 700
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1820
Practice Address - Country:US
Practice Address - Phone:713-272-1600
Practice Address - Fax:713-272-1615
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TXG2854207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159754401Medicaid
TX060070473OtherMEDICARE RAILROAD
TX159754401Medicaid
TX00422TMedicare ID - Type Unspecified
TX680497293OtherTIN