Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | OS 10417 | FL |
NPI | 1285831743 |
---|---|
Provider Name | Dr. Anthony Joseph Allotta III |
First Address | Titusville, FL 32796-2100 |
Second Address | Port St John, FL 32927-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000821200 | (05) | FL |