Provider Demographics
NPI:1104820067
Name:FONTE, ANGELO JR (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:FONTE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1965
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34274-1965
Mailing Address - Country:US
Mailing Address - Phone:941-586-7780
Mailing Address - Fax:
Practice Address - Street 1:115 TAMIAMI TRL N STE 7
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-2162
Practice Address - Country:US
Practice Address - Phone:941-586-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78804207L00000X, 208D00000X, 207LP2900X, 207R00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH27355Medicare UPIN
FL35828Medicare ID - Type UnspecifiedPROVIDER ID#