1154382836 NPI number — ALEXANDER T DOERFFLER MD

Table of content: ALEXANDER T DOERFFLER MD (NPI 1154382836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154382836 NPI number — ALEXANDER T DOERFFLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOERFFLER
Provider First Name:
ALEXANDER
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154382836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 NW 49TH ST
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-3723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-751-1157
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E SAMPLE RD
Provider Second Line Business Practice Location Address:
BROWARD HEALTH NORTH
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-941-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  44956 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: ME 118082 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44956 . This is a "MN MEDICAL LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 097313100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME 118082 . This is a "FLORIDA BOARD OF MEDICINE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010881500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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