Provider Demographics
NPI:1073539094
Name:ANTON, ALEXANDROS NICKOLAS (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDROS
Middle Name:NICKOLAS
Last Name:ANTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDROS
Other - Middle Name:N
Other - Last Name:ANTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4033 TAMPA RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-852-2003
Mailing Address - Fax:813-855-2367
Practice Address - Street 1:6550 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-4022
Practice Address - Country:US
Practice Address - Phone:813-968-2710
Practice Address - Fax:813-964-9170
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94465208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274177600Medicaid