| Entity Name: | ANTHONY DECOTIS, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 29 Dec 1988 (36 years ago) |
| Document Number: | K54504 |
| FEI/EIN Number | 59-2918630 |
| Address: | 131 BEAL PKWY NW, FT WALTON BCH, FL 32548 |
| Mail Address: | 131 BEAL PKWY NW, FT WALTON BCH, FL 32548 |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881930857 | 2012-12-19 | 2012-12-19 | 131 BEAL PKWY NW, FORT WALTON BEACH, FL, 325484358, US | 131 BEAL PKWY NW, FORT WALTON BEACH, FL, 325484358, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-243-8558 |
| Fax | 8503010147 |
Authorized person
| Name | DR. ANTHONY DECOTIS |
| Role | PRESIDENT/PHYSICIAN |
| Phone | 8502438558 |
Taxonomy
| Taxonomy Code | 207RR0500X - Rheumatology Physician |
| License Number | ME45093 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 047222100 |
| State | FL |
| Issuer | BLUE COSS BLUE SHIELD OF FLORIDA |
| Number | 17617 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DECOTIS, ANTHONY MD | Agent | 131 BEAL PARKWAY NW, FT WALTON BCH, FL 32548 |
| Name | Role | Address |
|---|---|---|
| DECOTIS, ANTHONY MD | DR. | 131 NW BEAL PKWY, FT WALTON BEACH, FL 32548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2009-03-25 | 131 BEAL PKWY NW, FT WALTON BCH, FL 32548 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1999-04-26 | 131 BEAL PARKWAY NW, FT WALTON BCH, FL 32548 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1997-05-05 | 131 BEAL PKWY NW, FT WALTON BCH, FL 32548 | No data |
| REGISTERED AGENT NAME CHANGED | 1997-05-05 | DECOTIS, ANTHONY MD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-04-19 |
| ANNUAL REPORT | 2021-04-25 |
| ANNUAL REPORT | 2020-06-14 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-28 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-13 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
