Provider Demographics
NPI:1407822208
Name:CONETTA, DONALD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANTHONY
Last Name:CONETTA
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:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP CARDIOLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-2060
Practice Address - Fax:904-244-3102
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26471207R00000X, 207RC0000X
GA060060207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0586137-00Medicaid
GA000135726BMedicaid
GA000135726CMedicaid
FL68111YMedicare PIN
FL110055907Medicare PIN
GA000135726CMedicaid
GAP00654531Medicare PIN