Provider Demographics
NPI:1275572489
Name:SPEIGHTS, ANTHONY C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:C
Last Name:SPEIGHTS
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 1:597 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2330
Mailing Address - Country:US
Mailing Address - Phone:850-872-4455
Mailing Address - Fax:850-747-5475
Practice Address - Street 1:597 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2330
Practice Address - Country:US
Practice Address - Phone:850-872-4455
Practice Address - Fax:850-747-5475
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016512700Medicaid
FL016512700Medicaid
I43649Medicare UPIN