Antonacci, Mark A.
Antonacci, Mark A. is an individual health care provider with primary practice located at 3551 Roger Brooke Dr , Fort Sam Houston TX 78234-4504. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Antonacci, Mark A. can be contacted via phone (850) 687-0316.Contact Information
Primary practice address
3551 Roger Brooke Dr
Fort Sam Houston TX 78234-4504
Phone: (850) 687-0316
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | ME82194 | Florida |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | P4138 | Texas |
Profile Details
| NPI number | 1083673016 |
|---|---|
| LBN Legal business name | Antonacci, Mark A. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 20th, 2006 |
| Last updated | Mar 1st, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083673016 | NPPES |
| Florida | Other | 01791 | BCBS |
| Florida | Other | 059191709 | BCBS |
| Florida | Other | 059191697 | BCBS |
| Florida | MEDICAID | 261491000 | BCBS |
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