Provider Demographics
NPI:1497843254
Name:DISCLAFANI, ANTONIO II (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:DISCLAFANI
Suffix:II
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 1:1901 SE 18TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8215
Mailing Address - Country:US
Mailing Address - Phone:352-622-3360
Mailing Address - Fax:352-671-3269
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-622-3360
Practice Address - Fax:352-671-3269
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 53493207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048887900Medicaid
FL048887900Medicaid
FL07341YMedicare PIN