Healthcare Provider Details

I. General information

NPI: 1871591180
Provider Name (Legal Business Name): SALVATORE ANZALONE MD, PACOG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 10TH ST N
NAPLES FL
34103-3866
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-1066
  • Fax: 239-262-2031
Mailing address:
  • Phone: 239-658-3064
  • Fax: 239-658-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME117687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: