Basic Information
| Provider Information | |||||||||
| NPI: | 1396749131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPONE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11528 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346681442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278682151 | ||||||||
| FaxNumber: | 7278688251 | ||||||||
| Practice Location | |||||||||
| Address1: | 11528 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346681442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278682151 | ||||||||
| FaxNumber: | 7278687379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 11/30/2009 | ||||||||
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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 | 207Q00000X | OS0003776 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 262621 | 01 | FL | AVMED | OTHER | 01372 | 01 | FL | UNIVERSAL | OTHER | 059405900 | 05 | FL | MEDICAID | 01-05310 | 01 | FL | UNITED HEALTH CARE | OTHER | 080074039 | 01 | FL | RAILROAD MEDICARE | OTHER | 11151702 | 01 | FL | CITRUS GCMC2 | OTHER | 2151031 | 01 | FL | AETNA HMO | OTHER | 82146 | 01 | FL | BLUE CROSS BLUE SHIELD OF FLORIDA | OTHER | 4658471 | 01 | FL | AETNA PPO | OTHER | 11151701 | 01 | FL | CITRUS GCMC 1 | OTHER | 6100347 | 01 | FL | GHI | OTHER |