Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD2010-0612 | NM |
Y | 207XS0117X | Orthopaedic Spine Surgeon | P67172 | NY |
NPI | 1255585865 |
---|---|
Provider Name | Dr. Antony Kallur Antony |
First Address | Albuquerque, NM 87102-1740 |
Second Address | Albuquerque, NM 87102-1740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 23/08/2011 |