Provider Demographics
NPI:1033156724
Name:DEJARNETTE, ALAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:SCOTT
Last Name:DEJARNETTE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 NE 14TH STREET CSWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3561
Mailing Address - Country:US
Mailing Address - Phone:954-942-8177
Mailing Address - Fax:954-942-1819
Practice Address - Street 1:2700 NE 14TH STREET CSWY
Practice Address - Street 2:SUITE 103
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3561
Practice Address - Country:US
Practice Address - Phone:954-942-8177
Practice Address - Fax:954-942-1819
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLFLME37486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP29266Medicare UPIN
FL11332UMedicare ID - Type Unspecified