1407943426 NPI number — ALLEN H BEZNER MD PA

Table of content: (NPI 1407943426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407943426 NPI number — ALLEN H BEZNER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEN H BEZNER MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1407943426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 JFK DR
Provider Second Line Business Mailing Address:
BLDG 110
Provider Business Mailing Address City Name:
ATLANTIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462-6606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-439-1234
Provider Business Mailing Address Fax Number:
561-439-0506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 JFK DR
Provider Second Line Business Practice Location Address:
BLDG 110
Provider Business Practice Location Address City Name:
ATLANTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462-6606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-439-1234
Provider Business Practice Location Address Fax Number:
561-439-0506
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEZNER
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-439-1234

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME38678 , 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: 02977 . This is a "WELLCARE/HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5945 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1003492 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 071095 . This is a "AV MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4099722 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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