Provider Demographics
NPI:1790818607
Name:APONTE, LUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
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 1:15861 WHITE ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6712
Mailing Address - Country:US
Mailing Address - Phone:573-614-2238
Mailing Address - Fax:321-240-9711
Practice Address - Street 1:2776 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5855
Practice Address - Country:US
Practice Address - Phone:239-343-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16113174400000X
MO2007034514207Q00000X
FLME107394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME107394OtherSTATE LICENSE
MO209915305Medicaid
FL002548500Medicaid
FLHD296AOtherMEDICARE PTAN GROUP
FL149CFOtherBCBS FL
MOP00437992OtherRAILROAD MEDICARE
FLDT8680OtherRAILROAD MEDICARE GROUP
FLP01106416OtherRR MEDICARE
MO891246OtherHEALTHLINK
FLME107394OtherSTATE LICENSE
PR16113OtherSTATE LICENCE
MO2007034514OtherSTATE LICENCE
FLDT8680OtherRAILROAD MEDICARE GROUP
FLME107394OtherSTATE LICENSE