Individual
DR. MARK M CASILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1139 E SONTERRA BLVD STE 205, SAN ANTONIO, TX 78258-4349
(210) 874-3359
Mailing address
1139 E SONTERRA BLVD STE 205, SAN ANTONIO, TX 78258-4349
(210) 874-3359
(210) 874-3369
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
J1917
TX
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
J1917
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048005502
—
TX
01
—
1676698
CIGNA
TX
01
—
5972563
AETNA
TX
01
—
8K6270
BCBS
TX
01
—
P00088532
RAILROAD MEDICARE
TX
Enumeration date
06/15/2006
Last updated
02/10/2022
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