Provider Demographics
NPI:1831340033
Name:ANTON, MANUEL PATRICIO III (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:PATRICIO
Last Name:ANTON
Suffix:III
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 1:450 E LAS OLAS BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2292
Mailing Address - Country:US
Mailing Address - Phone:954-767-5757
Mailing Address - Fax:
Practice Address - Street 1:450 E LAS OLAS BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2292
Practice Address - Country:US
Practice Address - Phone:954-767-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 60465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine