MEDICARE: DR. ANTONIO SABLAD BARTONICO 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
1	2084P0800X	Psychiatry Physician	G0896	TX

General Provider Information

NPI Number	:	1912188111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO SABLAD BARTONICO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 163085
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78716-3085
Country	:	US
Telephone Number	:	936-436-2084
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W CENTRAL TEXAS EXPY STE 208
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2080
Country	:	US
Telephone Number	:	254-681-3842
Fax Number	:

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

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	11/16/2007

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