MEDICARE: ANTHONY L UNDERWOOD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS5948	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134164106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY L UNDERWOOD DO

Provider Business Mailing Address
First Line	:	320 3RD ST
Second Line	:	SUITE B
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-5109
Country	:	US
Telephone Number	:	904-270-0767
Fax Number	:	904-694-0058

Provider Business Practice Location Address
First Line	:	320 3RD ST
Second Line	:	SUITE B
City	:	NEPTUNE BEACH
State	:	FL
Zip	:	32266-5109
Country	:	US
Telephone Number	:	904-270-0767
Fax Number	:	904-694-0058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	05/07/2014

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