Provider Demographics
NPI:1164418786
Name:STERN, ALAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:G
Last Name:STERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 S GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2704
Mailing Address - Country:US
Mailing Address - Phone:561-483-7397
Mailing Address - Fax:
Practice Address - Street 1:644 GLADES RD
Practice Address - Street 2:C/O BRRH COMMUNITY OUTREACH
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6414
Practice Address - Country:US
Practice Address - Phone:561-955-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
79502Medicare PIN