Basic Information
| Provider Information | |||||||||
| NPI: | 1356329056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMATY | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850001 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328850192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042826331 | ||||||||
| FaxNumber: | 9042821550 | ||||||||
| Practice Location | |||||||||
| Address1: | 14444 BEACH BLVD | ||||||||
| Address2: | SUITE 305B | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322502079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042236410 | ||||||||
| FaxNumber: | 9048219688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | ME0057642 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 208000000X | ME0057642 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 370016071 | 01 | FL | RRMCR | OTHER | 055515100 | 05 | FL | MEDICAID | 12299 | 01 | FL | BCBS | OTHER |