Provider Demographics
NPI:1093957649
Name:ANFUSO, ANTHONY JOSEPH JR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:ANFUSO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 DANIELS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4773
Mailing Address - Country:US
Mailing Address - Phone:239-291-6970
Mailing Address - Fax:239-264-1236
Practice Address - Street 1:13691 METRO PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4322
Practice Address - Country:US
Practice Address - Phone:239-291-6970
Practice Address - Fax:239-522-4288
Is Sole Proprietor?:No
Enumeration Date:2009-03-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118346207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9280321OtherCIGNA
FL011848700Medicaid
FLP01520280OtherRAILROAD MEDICARE
FL1035847OtherWELLCARE
FL14W4SOtherBCBS
FL4928705OtherAETNA
FL1566218OtherCOVENTRY
FL75121240OtherPRESTIGE HEALTH CHOICE
FLP1023983OtherFREEDOM
FLP962129OtherOPTIMUM
FL375100OtherAVMED
FL9280321OtherCIGNA