Provider Demographics
NPI:1932105434
Name:CAPASSO, ANTHONY L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
Last Name:CAPASSO
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:1351 13TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3234
Practice Address - Country:US
Practice Address - Phone:904-249-9995
Practice Address - Fax:904-249-9449
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0069518207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
28510AOtherBLUE CROSS BLUE SHIELD ID
28510AOtherBLUE CROSS BLUE SHIELD ID