=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700808391
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMEER ANDONI FINO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 11/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 N BELT LINE RD SUITE 105
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75149-1782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-288-9633
-----------------------------------------------------
Fax | 972-288-9699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1316 PRESCOTT DR
-----------------------------------------------------
City | MURPHY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75094-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-288-9633
-----------------------------------------------------
Fax | 972-288-9699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | J2004
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------