Provider Demographics
NPI:1821144981
Name:SOTELO, OSCAR (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:SOTELO
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 1:7012 N 10TH ST
Mailing Address - Street 2:STE 40
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3397
Mailing Address - Country:US
Mailing Address - Phone:956-682-1591
Mailing Address - Fax:956-682-1592
Practice Address - Street 1:7012 N 10TH ST
Practice Address - Street 2:STE 40
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3397
Practice Address - Country:US
Practice Address - Phone:956-682-1591
Practice Address - Fax:956-682-1592
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD-5212174400000X
TXD5212207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1155491-03Medicaid
TX8CQ495OtherBCBS
TX071900037OtherRAILROAD MEDICARE
TX1155491-04Medicaid
TX1155491-03Medicaid
TX1155491-04Medicaid
TX00U37AMedicare ID - Type Unspecified