Provider Demographics
NPI:1619070968
Name:ADNOT, JOHN
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ADNOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ADNOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4200 S. HULEN ST.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4912
Mailing Address - Country:US
Mailing Address - Phone:817-377-0626
Mailing Address - Fax:817-377-4161
Practice Address - Street 1:4200 S. HULEN ST.
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4912
Practice Address - Country:US
Practice Address - Phone:817-377-0626
Practice Address - Fax:817-377-4161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5828207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032608401Medicaid
TXD19KMedicare ID - Type Unspecified
TX032608401Medicaid