Provider Demographics
NPI:1790765758
Name:ANTON, AMERICO B (MD)
Entity Type:Individual
Prefix:
First Name:AMERICO
Middle Name:B
Last Name:ANTON
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 1:12521 EQUINE LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3507
Mailing Address - Country:US
Mailing Address - Phone:561-793-0291
Mailing Address - Fax:888-980-9984
Practice Address - Street 1:12521 EQUINE LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3507
Practice Address - Country:US
Practice Address - Phone:561-793-0291
Practice Address - Fax:888-980-9984
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111152207Q00000X
PAMD015243E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C32911Medicare UPIN