MEDICARE: MR. ANTONIO S ALKHAFAJI

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	172A00000X	Driver	34320510	TX

General Provider Information

NPI Number	:	1811506892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTONIO S ALKHAFAJI

Provider Business Mailing Address
First Line	:	1601 PURPLETOP DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3727
Country	:	US
Telephone Number	:	682-888-3827
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 PURPLETOP DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3727
Country	:	US
Telephone Number	:	682-888-3827
Fax Number	:

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

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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Directions to “ MR. ANTONIO S ALKHAFAJI ” Practice Location

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