Provider Demographics
NPI:1164623955
Name:ALTMAN, JASON IAN (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:IAN
Last Name:ALTMAN
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 1:550 BILTMORE WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5730
Mailing Address - Country:US
Mailing Address - Phone:305-446-7700
Mailing Address - Fax:
Practice Address - Street 1:550 BILTMORE WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5730
Practice Address - Country:US
Practice Address - Phone:305-446-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101023208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery