Healthcare Provider Details

I. General information

NPI: 1760635429
Provider Name (Legal Business Name): ANTHONY WARE ORTHOPAEDICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 BROADBAND DR SUITE F1
MELBOURNE FL
32901-2623
US

IV. Provider business mailing address

150 N SYKES CREEK PKWY # 300
MERRITT ISLAND FL
32953-3488
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-9310
  • Fax: 321-752-5218
Mailing address:
  • Phone: 321-449-4168
  • Fax: 321-449-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0076509
License Number StateFL

VIII. Authorized Official

Name: SANDI LAROCHE
Title or Position: MSO CREDENTIALING COORDINATOR
Credential:
Phone: 321-449-4168