MEDICARE: DR. JOHN ANTHONY RACANELLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	H5479	TX
2	207X00000X	Orthopaedic Surgery Physician	09332R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	82V191	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619986692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY RACANELLI MD

Provider Business Mailing Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	STE 130, LB 11
City	:	DALLAS
State	:	TX
Zip	:	75231-4418
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:	214-739-5029

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	STE 130, LB 11
City	:	DALLAS
State	:	TX
Zip	:	75231-4418
Country	:	US
Telephone Number	:	214-750-1207
Fax Number	:	214-739-5029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	06/16/2009

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Directions to “ DR. JOHN ANTHONY RACANELLI MD” Practice Location

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