Individual
DR. ANTHONY J. DERAIMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5151 N 9TH AVE, PENSACOLA, FL 32504-8721
(850) 416-6020
Mailing address
PO BOX 9210, PENSACOLA, FL 32513-9210
(850) 476-8602
(850) 474-3518
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
ME0048453
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME0048453
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009003570
ALABAMA EDS MEDICAID
AL
05
—
043212100
—
FL
01
—
17663
BCBS OF FLORIDA
FL
01
—
300070293
RR MEDICARD
FL
01
—
57477
BCBS OF ALABAMA
AL
Enumeration date
03/28/2006
Last updated
03/12/2014
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