Provider Demographics
NPI:1164605846
Name:ROGER W. ALTMAN,M.D.PA
Entity Type:Organization
Organization Name:ROGER W. ALTMAN,M.D.PA
Other - Org Name:ROGER W. ALTMAN,M.D.PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-785-7667
Mailing Address - Street 1:32615 US 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 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41151207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4083Medicare PIN