Healthcare Provider Details

I. General information

NPI: 1053392175
Provider Name (Legal Business Name): PATRICIA MARY ANTERO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HARGROVE RD E
TUSCALOOSA AL
35401-5027
US

IV. Provider business mailing address

215 HARGROVE RD E
TUSCALOOSA AL
35401-5027
US

V. Phone/Fax

Practice location:
  • Phone: 205-758-8809
  • Fax: 205-758-8870
Mailing address:
  • Phone: 205-758-8809
  • Fax: 205-758-8870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00136
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: