Provider Demographics
NPI:1174703425
Name:SOTIROPOULOS, ANASTASIOS (DPM)
Entity type:Individual
Prefix:
First Name:ANASTASIOS
Middle Name:
Last Name:SOTIROPOULOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38561
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-0561
Mailing Address - Country:US
Mailing Address - Phone:469-223-0606
Mailing Address - Fax:
Practice Address - Street 1:13021 COIT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5789
Practice Address - Country:US
Practice Address - Phone:469-223-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1621213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0053JBOtherBLUE CROSS BLUE SHIELD
P00217354OtherMEDICARE RAILROAD
TX00393YOtherMEDICARE GROUP ID
TX1621OtherMEDICAL LICENSE
5519790002Medicare NSC
P00217354OtherMEDICARE RAILROAD
5519790001Medicare NSC
TX8D309Medicare PIN