Provider Demographics
NPI:1619986692
Name:RACANELLI, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:RACANELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:STE 130, LB 11
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4418
Mailing Address - Country:US
Mailing Address - Phone:214-750-1207
Mailing Address - Fax:214-739-5029
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:STE 130, LB 11
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4418
Practice Address - Country:US
Practice Address - Phone:214-750-1207
Practice Address - Fax:214-739-5029
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5479207X00000X
LA09332R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103395302Medicaid
TX82V191OtherBCBS
TX103395301Medicaid
TX82V191Medicare PIN
TX200033792Medicare PIN
TX103395301Medicaid
TX89381BMedicare PIN