Provider Demographics
NPI:1265494827
Name:ANTONINI, TOMAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:G
Last Name:ANTONINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3407 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1448
Mailing Address - Country:US
Mailing Address - Phone:512-716-0861
Mailing Address - Fax:866-765-3913
Practice Address - Street 1:3407 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1448
Practice Address - Country:US
Practice Address - Phone:512-716-0861
Practice Address - Fax:866-765-3913
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4221207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y617Medicare PIN