Healthcare Provider Details

I. General information

NPI: 1356329056
Provider Name (Legal Business Name): ANTHONY EDWARD HAMATY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14444 BEACH BLVD SUITE 305B
JACKSONVILLE FL
32250-2079
US

IV. Provider business mailing address

PO BOX 850001
ORLANDO FL
32885-0192
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-6410
  • Fax: 904-821-9688
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-282-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME0057642
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0057642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: