Provider Demographics
NPI:1053392175
Name:ANTERO, PATRICIA MARY (DPM)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARY
Last Name:ANTERO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 HARGROVE RD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-5027
Mailing Address - Country:US
Mailing Address - Phone:205-758-8809
Mailing Address - Fax:205-758-8870
Practice Address - Street 1:215 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5027
Practice Address - Country:US
Practice Address - Phone:205-758-8809
Practice Address - Fax:205-758-8870
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00136213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1041420001Medicare NSC
AL000074235Medicare PIN
ALU27894Medicare UPIN