Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | A112815 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | P3071 | TX |
NPI | 1073713079 |
---|---|
Provider Name | Vinod Antony Sebastian |
First Address | Fort Worth, TX 76199-0371 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 06/04/2015 |