Healthcare Provider Details

I. General information

NPI: 1912375429
Provider Name (Legal Business Name): BONEPRO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 HARBOR DR
BELLEAIR BEACH FL
33786-3261
US

IV. Provider business mailing address

903 HARBOR DR
BELLEAIR BEACH FL
33786-3261
US

V. Phone/Fax

Practice location:
  • Phone: 727-379-2106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS10623
License Number StateFL

VIII. Authorized Official

Name: DR. ANTHONY LOUIS MARCOTTE
Title or Position: ORTHOPAEDIC SURGEON
Credential: D.O.
Phone: 727-379-2106