Provider Demographics
NPI:1700808656
Name:AMOFAH, SAINT ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:SAINT
Middle Name:ANTHONY
Last Name:AMOFAH
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 1:11535 SW 100TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:305-252-4837
Practice Address - Street 1:10300 SW 216TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1003
Practice Address - Country:US
Practice Address - Phone:305-253-5100
Practice Address - Fax:305-252-4837
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0072174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37705OtherBLUE CROSS BLUE SHIELD
FL255286800Medicaid
FL37705OtherBLUE CROSS BLUE SHIELD
FLE4000ZMedicare ID - Type Unspecified