Provider Demographics
NPI:1164513727
Name:CANTON, ENRIQUE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:J
Last Name:CANTON
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 1:9360 SW 72ND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5432
Mailing Address - Country:US
Mailing Address - Phone:305-596-3100
Mailing Address - Fax:305-596-3909
Practice Address - Street 1:9360 SW 72ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5432
Practice Address - Country:US
Practice Address - Phone:305-596-3100
Practice Address - Fax:305-596-3909
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD-63455Medicare UPIN