Provider Demographics
NPI:1245226208
Name:ANTONETTI, EMILIO A (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:A
Last Name:ANTONETTI
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 1:6160 N DAVIS HWY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6994
Mailing Address - Country:US
Mailing Address - Phone:850-202-1380
Mailing Address - Fax:850-478-4927
Practice Address - Street 1:6160 N DAVIS HWY
Practice Address - Street 2:SUITE 11
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6994
Practice Address - Country:US
Practice Address - Phone:850-202-1380
Practice Address - Fax:850-478-4927
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44615207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59049656OtherBLUECROSS BLUESHIELD
FLZ105OtherHEALTH FIRST NETWORK
FL069437100Medicaid
FL94368OtherBLUECROSS BLUESHIELD
FL069437100Medicaid
FL94368OtherBLUECROSS BLUESHIELD
FL94368Medicare ID - Type Unspecified