Provider Demographics
NPI:1801816814
Name:ANTON, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
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:PO BOX 11137
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1137
Mailing Address - Country:US
Mailing Address - Phone:304-344-3457
Mailing Address - Fax:304-344-3480
Practice Address - Street 1:725 GULF SHORE BLVD S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6829
Practice Address - Country:US
Practice Address - Phone:304-344-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME588722085R0202X
OH35.1322652085R0202X
WV298182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA012306171AMedicaid
GAN356813OtherWELLCARE
GA30BDNCXMedicare PIN
GA52494272004OtherBCBS
GA012306171AOtherPEACH STATE HEALTH PLAN
GA10069116OtherAMERIGROUP
GAF22724Medicare UPIN
GAP00340703OtherRAILROAD MEDICARE