Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | P2946 | TX |
NPI | 1023283017 |
---|---|
Provider Name | Dr. Jodi Antonelli |
First Address | Dallas, TX 75390-9110 |
Second Address | Dallas, TX 75390-9110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 15/02/2016 |