Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | E1491 | TX |
Y | 208600000X | Surgeon | E1491 | TX |
NPI | 1023103009 |
---|---|
Provider Name | Dr. Alfredo Ricardo Antonetti |
First Address | Plano, TX 75093-4640 |
Second Address | Plano, TX 75093-4640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 18/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0894826-01 | (05) | TX |
089482603 | (05) | TX |
C12895 | (02) | |
C12895 | (02) | TX |