MEDICARE: DR. VINAY ANTIN D.O.

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	207RG0100X	Gastroenterology Physician	P1261	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8FZ062	OTHER	TX	BCBS TX

General Provider Information

NPI Number	:	1316224116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINAY ANTIN D.O.

Provider Business Mailing Address
First Line	:	7610 N STEMMONS FWY STE 600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4228
Country	:	US
Telephone Number	:	214-689-5960
Fax Number	:	469-713-8084

Provider Business Practice Location Address
First Line	:	4375 BOOTH CALLOWAY RD STE 307
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8364
Country	:	US
Telephone Number	:	682-463-0400
Fax Number	:	682-463-0405

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

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	09/25/2020

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