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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
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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