Healthcare Provider Details

I. General information

NPI: 1174560643
Provider Name (Legal Business Name): JOSEPH D'ANTONIO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 201
LAS CRUCES NM
88011-8260
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE 201
LAS CRUCES NM
88011-8260
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-2233
  • Fax: 575-522-2266
Mailing address:
  • Phone: 575-522-2233
  • Fax: 575-522-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0022409
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2012-0524
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: