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NPI Code Detail

MEDICARE: DR. RONALD L ANTINONE M.D.

MEDICARE:  DR. RONALD L ANTINONE  M.D.
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
1174400000XSpecialistD5664TX

General Provider Information

NPI Number : 1659371490
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD L ANTINONE M.D.
Provider Business Mailing Address
First Line : 901 TRAVIS AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3137
Country : US
Telephone Number : 817-338-0322
Fax Number : 817-338-0624
Provider Business Practice Location Address
First Line : 901 TRAVIS AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3137
Country : US
Telephone Number : 817-338-0322
Fax Number : 817-338-0624
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 07/08/2007

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Directions to “ DR. RONALD L ANTINONE M.D.” Practice Location

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