Provider Demographics
NPI:1871544247
Name:SOEGAARD, ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SOEGAARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANTONIO
Other - Middle Name:
Other - Last Name:SOEGAARD-TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1405 SE GOLDTREE DR STE D
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7563
Mailing Address - Country:US
Mailing Address - Phone:772-800-7001
Mailing Address - Fax:772-877-3539
Practice Address - Street 1:1405 SE GOLDTREE DR STE D
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7563
Practice Address - Country:US
Practice Address - Phone:772-800-7001
Practice Address - Fax:772-877-3539
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275927-06Medicaid
TX164336301Medicaid
TX0074DFOtherBSBS
TXP00089646OtherRR MEDICARE
TX0074DFOtherBSBS
TXP00089646OtherRR MEDICARE