Provider Demographics
NPI:1700142742
Name:VITALE, DOMINICK ANTHONY (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:ANTHONY
Last Name:VITALE
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11212 STATE HIGHWAY 151 STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4501
Mailing Address - Country:US
Mailing Address - Phone:210-703-8556
Mailing Address - Fax:
Practice Address - Street 1:11212 TX-151
Practice Address - Street 2:MEDICAL PLAZA I, STE 230
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4501
Practice Address - Country:US
Practice Address - Phone:210-703-8556
Practice Address - Fax:210-703-8557
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS30842086S0102X, 2086S0127X, 208600000X, 208600000X, 2086S0127X
NY27460012086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery