Provider Demographics
NPI:1093745028
Name:NUNEZ, ANTHONY IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:IAN
Last Name:NUNEZ
Suffix:
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 1:737 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4936
Mailing Address - Country:US
Mailing Address - Phone:407-279-0334
Mailing Address - Fax:407-557-3264
Practice Address - Street 1:737 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4937
Practice Address - Country:US
Practice Address - Phone:407-279-0334
Practice Address - Fax:407-557-3264
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090367208G00000X
FLME121555208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0254957Medicaid
IL036114512Medicaid
FL013400800Medicaid