Antenucci, Mark David

Antenucci, Mark David is an individual health care provider with primary practice located at 313 West Country Club Rd. Ste. 7, Roswell NM 88201. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Antenucci, Mark David can be contacted via phone (575) 624-2398.

Contact Information

Primary practice address
313 West Country Club Rd. Ste. 7 Roswell NM 88201
Phone: (575) 624-2398
Fax: (575) 624-0655
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 184 New Mexico

Profile Details

NPI number 1760490759
LBN Legal business name Antenucci, Mark David
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 4th, 2006
Last updated Jun 24th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760490759 NPPES
New Mexico MEDICAID 55657

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