Basic Information
| Provider Information | |||||||||
| NPI: | 1295868883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VISINTINE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7121 SOUTH PADRE ISLAND DRIVE, | ||||||||
| Address2: | SUITE 118 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616946054 | ||||||||
| FaxNumber: | 3619801248 | ||||||||
| Practice Location | |||||||||
| Address1: | 7121 SOUTH PADRE ISLAND DRIVE, | ||||||||
| Address2: | SUITE 118 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616946054 | ||||||||
| FaxNumber: | 3619801248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 08/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 12591 | NV | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207VM0101X | 12591 | NV | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207V00000X | 3376 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 3376 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1295868883 | 05 | NV | MEDICAID | 205535201 | 05 | TX | MEDICAID |