Provider Demographics
NPI:1790842201
Name:CAMMACK, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:CAMMACK
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 1:7552 NAVARRE PKWY
Mailing Address - Street 2:UNIT 45
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7305
Mailing Address - Country:US
Mailing Address - Phone:850-936-9665
Mailing Address - Fax:850-936-4476
Practice Address - Street 1:7552 NAVARRE PKWY
Practice Address - Street 2:UNIT 45
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7305
Practice Address - Country:US
Practice Address - Phone:850-936-9665
Practice Address - Fax:850-936-4476
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28400CMedicare ID - Type Unspecified
G26665Medicare UPIN