Individual
SCOTT ANTONIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12902 USF MAGNOLIA DR, MDC 44, TAMPA, FL 33612-9416
(813) 745-4673
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
(866) 761-5658
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME68757
FL
207RX0202X
Medical Oncology Physician
Primary
ME68757
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25541
BLUE CROSS BLUE SHIELD
FL
05
—
375600900
—
FL
Enumeration date
07/07/2006
Last updated
02/05/2014
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