Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 17710 | MS |
NPI | 1215966130 |
---|---|
Provider Name | Dr. James A Antinnes |
First Address | Hattiesburg, MS 39401-8246 |
Second Address | Hattiesburg, MS 39401-8246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 23/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00125867 | (05) | MS |
200000457 | (02) | MS |
H49391 | (02) | MS |