Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 31106 | TX |
Y | 213EG0000X | General Practice | 31106 | TX |
NPI | 1003299868 |
---|---|
Provider Name | Dr. Joseph Anthony Dibartolo |
First Address | League City, TX 77573-9068 |
Second Address | Pasadena, TX 77504-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2015 |
Last Update Date | 19/07/2015 |