1518026475 NPI number — DR. ALAN A NETZMAN DO, PA

Table of content: DR. ALAN A NETZMAN DO, PA (NPI 1518026475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518026475 NPI number — DR. ALAN A NETZMAN DO, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NETZMAN
Provider First Name:
ALAN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO, PA
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:
1518026475
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5701 OVERSEAS HWY
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
MARATHON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33050-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-743-3511
Provider Business Mailing Address Fax Number:
305-743-2765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5701 OVERSEAS HWY
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
MARATHON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33050-2784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-743-3511
Provider Business Practice Location Address Fax Number:
305-743-2765
Provider Enumeration Date:
12/07/2006

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: 208600000X , with the licence number:  OS4620 , 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: 1598927386 . This is a "NPI ORGANIZATIONAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82785 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 040023800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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