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General NPI Number Information
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NPI Number | 1790093672
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Entity Type | Organization
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Legal Business Name | CHET ANTHONY DO, INC.
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 24239 STATE ROAD 40
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City | ASTOR
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State | FL
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Zip | 32102-3029
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Country | US
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Telephone | 352-759-3900
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Fax | 352-759-3800
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Provider Business Mailing Address
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Address Line | 24239 STATE ROAD 40
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City | ASTOR
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State | FL
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Zip | 32102-3029
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Country | US
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Telephone | 352-759-3900
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Fax | 352-759-3800
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TAMMY C ROSS
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Credential |
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Telephone | 352-759-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS8209
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License Number State | FL
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