Provider Demographics
NPI:1053306951
Name:THROWER, ANGELO PERRY (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:PERRY
Last Name:THROWER
Suffix:
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 1:17901 NW 5TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2810
Mailing Address - Country:US
Mailing Address - Phone:305-757-9797
Mailing Address - Fax:305-757-9267
Practice Address - Street 1:17901 NW 5TH ST STE 205
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2810
Practice Address - Country:US
Practice Address - Phone:305-757-9797
Practice Address - Fax:305-757-9267
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57979207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL234156OtherAVMED
FL052148500Medicaid
FL650248448OtherTAX ID
FL234156OtherAVMED
FLE58287Medicare UPIN