Provider Demographics
NPI:1134174436
Name:ANTEZANA, JAMES N (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
Last Name:ANTEZANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10512 PARK RD
Mailing Address - Street 2:STE. 111
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8475
Mailing Address - Country:US
Mailing Address - Phone:704-910-8380
Mailing Address - Fax:704-973-0737
Practice Address - Street 1:10512 PARK RD STE 111
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8469
Practice Address - Country:US
Practice Address - Phone:704-910-8380
Practice Address - Fax:704-817-9980
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00158208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI51820Medicare UPIN
2073643AMedicare PIN