Organization
ANTHONY DECOTIS, M.D.,P.A.
Active
Organization
ANTHONY DECOTIS, M.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY DECOTIS M.D. (PRESIDENT/PHYSICIAN)
(850) 243-8558
Entity
Organization
Contact information
Practice address
131 BEAL PKWY NW, FORT WALTON BEACH, FL 32548-4358
(850) 243-8558
(850) 301-0147
Mailing address
131 BEAL PKWY NW, FORT WALTON BEACH, FL 32548-4358
(850) 243-8558
(850) 301-0147
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
ME45093
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047222100
—
FL
01
—
17617
BLUE COSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
12/19/2012
Last updated
12/19/2012
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