Provider Demographics
NPI:1437230505
Name:APONTE, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:APONTE
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 4542
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33677-4542
Mailing Address - Country:US
Mailing Address - Phone:813-489-6212
Mailing Address - Fax:813-489-6214
Practice Address - Street 1:301 W PLATT ST # 30
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2292
Practice Address - Country:US
Practice Address - Phone:813-489-6212
Practice Address - Fax:813-489-6214
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL963142086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001701600Medicaid
FL001701600Medicaid