Provider Demographics
NPI:1285831743
Name:ALLOTTA, ANTHONY JOSEPH III (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:ALLOTTA
Suffix:III
Gender:M
Credentials:DO
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Mailing Address - Street 1:805 CENTURY MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-268-6264
Mailing Address - Fax:321-635-9310
Practice Address - Street 1:5005 PORT ST JOHN PKWY # 2100
Practice Address - Street 2:PARRISH MEDICAL GROUP
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-433-2247
Practice Address - Fax:321-635-9310
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2021-04-20
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Provider Licenses
StateLicense IDTaxonomies
FLOS 10417207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000821200Medicaid
FLBI558ZMedicare PIN