MEDICARE: GLORIOSA ANTIPORDA, M.D.,P.A.

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	207Q00000X	Family Medicine Physician	ME49981	FL
2	207R00000X	Internal Medicine Physician	ME47869	FL

General Provider Information

NPI Number	:	1710125349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLORIOSA ANTIPORDA, M.D.,P.A.

Provider Business Mailing Address
First Line	:	PO BOX 850001
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32885-0001
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-282-1550

Provider Business Practice Location Address
First Line	:	2040 RIVERVIEW ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2657
Country	:	US
Telephone Number	:	904-713-8074
Fax Number	:	904-924-8217

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GLORIOSA R ANTIPORDA
Credential	:	M.D.
Telephone Number	:	904-713-8074

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	02/04/2009

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