Provider Demographics
NPI:1871650465
Name:ANTHONY, CHET (DO)
Entity Type:Individual
Prefix:
First Name:CHET
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24239 STATE ROAD 40
Mailing Address - Street 2:
Mailing Address - City:ASTOR
Mailing Address - State:FL
Mailing Address - Zip Code:32102-3029
Mailing Address - Country:US
Mailing Address - Phone:352-759-3900
Mailing Address - Fax:352-759-3800
Practice Address - Street 1:24239 STATE ROAD 40
Practice Address - Street 2:
Practice Address - City:ASTOR
Practice Address - State:FL
Practice Address - Zip Code:32102-3029
Practice Address - Country:US
Practice Address - Phone:352-759-3900
Practice Address - Fax:352-759-3800
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03178AMedicare ID - Type Unspecified