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General NPI Number Information
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NPI Number | 1699936492
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Entity Type | Organization
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Legal Business Name | DR. ANTHONY L. CAPASSO M. D.
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 1351 13TH AVE S STE # 110
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3234
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Country | US
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Telephone | 904-249-9995
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Fax | 904-249-9449
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Provider Business Mailing Address
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Address Line | 1351 13TH AVE S STE # 110
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3234
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Country | US
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Telephone | 904-249-9995
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Fax | 904-249-9449
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Authorized Official
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Title or Position | CEO OF CORPORATION
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Name | DR. ANTHONY L CAPASSO
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Credential | M.D.
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Telephone | 904-249-9995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 69518
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License Number State | FL
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