Provider Demographics
NPI:1093002768
Name:WASHINGTON, ANTHONY ROOSEVELT III (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ROOSEVELT
Last Name:WASHINGTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13608 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9638
Mailing Address - Country:US
Mailing Address - Phone:813-749-0167
Mailing Address - Fax:
Practice Address - Street 1:13608 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635
Practice Address - Country:US
Practice Address - Phone:813-749-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN64989207Q00000X
MS816-L207Q00000X
MEMD23047207Q00000X
TNMD0000058679207Q00000X
FLME118205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine