Provider Demographics
NPI:1205877214
Name:ASIS, ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:ASIS
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 1:2665 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2302
Mailing Address - Country:US
Mailing Address - Phone:940-387-8763
Mailing Address - Fax:940-535-5901
Practice Address - Street 1:2665 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2302
Practice Address - Country:US
Practice Address - Phone:940-387-8763
Practice Address - Fax:940-535-5901
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034987207V00000X
TXN4264207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215000501Medicaid
TX215000502Medicaid
CT1349879Medicaid
TX215000503OtherMEDICAID OTHER
CT1349879Medicaid
TX215000501Medicaid
TXTXB107184Medicare PIN
TXTXB107184Medicare PIN