Individual
ANTONIO P SISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0387
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0387
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J3614
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187988401
—
TX
01
—
P00441376
MEDICARE RAILROAD
—
Enumeration date
09/27/2006
Last updated
08/21/2012
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