Provider Demographics
NPI:1003898099
Name:ALTMAN, ROGER WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:WILLIAM
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:32615 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3176
Mailing Address - Country:US
Mailing Address - Phone:727-785-7667
Mailing Address - Fax:727-787-4543
Practice Address - Street 1:32615 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 1
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3176
Practice Address - Country:US
Practice Address - Phone:727-785-7667
Practice Address - Fax:727-787-4543
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME41151207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57435Medicare UPIN
FL62396AMedicare PIN