Provider Demographics
NPI:1598709305
Name:CASILLAS, MARK M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:CASILLAS
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 1:1139 E SONTERRA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4349
Mailing Address - Country:US
Mailing Address - Phone:210-874-3359
Mailing Address - Fax:210-874-3369
Practice Address - Street 1:1139 E SONTERRA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4349
Practice Address - Country:US
Practice Address - Phone:210-874-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1917207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5972563OtherAETNA
TX8K6270OtherBCBS
TX048005502Medicaid
TXP00088532OtherRAILROAD MEDICARE
TX1676698OtherCIGNA
TXP00088532OtherRAILROAD MEDICARE
TX5972563OtherAETNA