Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 02003509A | IN |
NPI | 1013006972 |
---|---|
Provider Name | Dr. Anton Alexi Cabellon |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 18/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200952960 | (05) | IN |