Healthcare Provider Details

I. General information

NPI: 1902969264
Provider Name (Legal Business Name): ANTHONY IAN RICCIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WELBORN ST TEXAS SCOTTISH RITE HOSPITAL
DALLAS TX
75219-3924
US

IV. Provider business mailing address

2222 WELBORN STREET
DALLAS TX
75219-3924
US

V. Phone/Fax

Practice location:
  • Phone: 214-559-5136
  • Fax: 214-559-7309
Mailing address:
  • Phone: 214-559-5000
  • Fax: 214-443-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberM2044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: