Healthcare Provider Details

I. General information

NPI: 1982875621
Provider Name (Legal Business Name): ANTONIO POTO JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 NW PEACOCK BLVD STE 205
PORT ST LUCIE FL
34986-2271
US

IV. Provider business mailing address

8491 S US HIGHWAY 1
PORT ST LUCIE FL
34952-3360
US

V. Phone/Fax

Practice location:
  • Phone: 772-446-4883
  • Fax: 772-446-4875
Mailing address:
  • Phone: 772-446-4883
  • Fax: 772-446-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOT011288
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOT011288
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS10791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: