Provider Demographics
NPI:1982875621
Name:POTO, ANTONIO JR (DO)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:POTO
Suffix:JR
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 1:8491 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3360
Mailing Address - Country:US
Mailing Address - Phone:772-446-4883
Mailing Address - Fax:772-446-4875
Practice Address - Street 1:8491 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3360
Practice Address - Country:US
Practice Address - Phone:772-446-4883
Practice Address - Fax:772-446-4875
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011288207L00000X, 208VP0014X
FLOS10791207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine