Individual
DR. RAUL M PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 BROOKLYN AVE STE 115, SAN ANTONIO, TX 78212-4815
(210) 224-6531
(210) 226-0402
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 437-9605
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
G4193
TX
207RX0202X
Medical Oncology Physician
G4193
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000V5772
—
NM
05
—
123759601
—
TX
05
—
123759602
—
TX
05
—
177173501
—
TX
01
—
8R1527
BLUE CROSS OF TEXAS
TX
Enumeration date
06/09/2006
Last updated
03/29/2018
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