Individual
DR. MARK A. ANTONACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(850) 687-0316
Mailing address
318 TRANQUIL OAK, SAN ANTONIO, TX 78260-3504
(850) 687-0316
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME82194
FL
207P00000X
Emergency Medicine Physician
Primary
P4138
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01791
BCBS
FL
01
—
059191697
BCBS
AL
01
—
059191709
BCBS
AL
05
—
261491000
—
FL
Enumeration date
03/20/2006
Last updated
12/05/2024
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