Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 00136 | AL |
NPI | 1053392175 |
---|---|
Provider Name | Dr. Patricia Mary Antero |
First Address | Tuscaloosa, AL 35401-5027 |
Second Address | Tuscaloosa, AL 35401-5027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 19/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U27894 | (02) | AL |