Organization
MARSHALL M. DESANTIS, M.D.,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARSHALL MATTHEW DESANTIS, M.D. (EMPLOYER)
(727) 869-7497
Entity
Organization
Contact information
Practice address
14100 FIVAY RD, SUITE 300, HUDSON, FL 34667-7180
(727) 869-7497
(727) 869-7156
Mailing address
14100 FIVAY RD, SUITE 300, HUDSON, FL 34667-7180
(727) 869-7497
(727) 869-7156
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME53627
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048693100
—
FL
01
—
05632
WELLCARE
FL
01
—
07035
BLUE CROSS BLUE SHIELD
FL
01
—
083596
AV MED
FL
01
—
1467542498
UNITED
FL
01
—
4049845
AETNA
FL
01
—
593277301
UNIVERSAL
FL
01
—
PRO0035
QUALITY
FL
Enumeration date
05/10/2009
Last updated
05/10/2009
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