MEDICARE: DR. ANTHONY L CAPASSO M.D.

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	207R00000X	Internal Medicine Physician	ME 0069518	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28510A	OTHER		BLUE CROSS BLUE SHIELD ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932105434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY L CAPASSO M.D.

Provider Business Mailing Address
First Line	:	1351 13TH AVE S STE 110
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3237
Country	:	US
Telephone Number	:	904-694-0992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 13TH AVE S STE 105-110
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3234
Country	:	US
Telephone Number	:	904-694-0992
Fax Number	:	904-595-5344

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	05/29/2024

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