Provider Demographics
NPI:1770579427
Name:ANCONA, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ANCONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-432-1771
Mailing Address - Fax:954-432-2722
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:SUITE 365
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-432-1771
Practice Address - Fax:954-432-2722
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME44382207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D51331Medicare UPIN
068792800Medicare ID - Type Unspecified