MEDICARE: ALEXANDROS NICKOLAS ANTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME94465	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073539094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDROS NICKOLAS ANTON MD

Provider Business Mailing Address
First Line	:	4033 TAMPA RD
Second Line	:	STE. 101
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3224
Country	:	US
Telephone Number	:	813-852-2003
Fax Number	:	813-855-2367

Provider Business Practice Location Address
First Line	:	6550 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4022
Country	:	US
Telephone Number	:	813-968-2710
Fax Number	:	813-964-9170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	06/09/2021

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