Individual
DR. ANTONIO SISON VICENCIO III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21 HOSPITAL DR, SUITE 230, PALM COAST, FL 32164-2452
(386) 586-3466
(386) 586-3467
Mailing address
PO BOX 354339, PALM COAST, FL 32135-4339
(386) 586-3466
(386) 586-3467
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME89537
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01156032
—
NY
01
—
43263
BC/BS
FL
Enumeration date
04/09/2007
Last updated
07/15/2010
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