Provider Demographics
NPI:1770601163
Name:STILLPOINT MEDICAL GROUP P.A.
Entity type:Organization
Organization Name:STILLPOINT MEDICAL GROUP P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-524-8786
Mailing Address - Street 1:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78297-1934
Mailing Address - Country:US
Mailing Address - Phone:818-524-8786
Mailing Address - Fax:
Practice Address - Street 1:2421 WORTH ST
Practice Address - Street 2:
Practice Address - City:HEMPHILL
Practice Address - State:TX
Practice Address - Zip Code:75948-7215
Practice Address - Country:US
Practice Address - Phone:409-787-3772
Practice Address - Fax:409-787-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC3918207Q00000X
TXG60022084A0401X, 2084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08478320Medicaid
TXG6002OtherTEXAS MEDICAL LICENSE
TXC21193Medicare UPIN
TX00R43HMedicare ID - Type UnspecifiedPSYCHIATRIST