Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | Q0940 | TX |
NPI | 1023214475 |
---|---|
Provider Name | Dr. Andrew Albert Indresano |
First Address | Fort Worth, TX 76177-8614 |
Second Address | Fort Worth, TX 76177-8614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 05/01/2022 |