Provider Demographics
NPI:1205813508
Name:KAGAN, ALAN R (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:KAGAN
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 1:2880 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4671
Mailing Address - Country:US
Mailing Address - Phone:850-656-5523
Mailing Address - Fax:850-222-1194
Practice Address - Street 1:2880 CAPITAL MEDICAL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4671
Practice Address - Country:US
Practice Address - Phone:850-656-5523
Practice Address - Fax:850-222-1194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00544392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08286OtherBC/BS PROVIDER NUMBER
FL08286OtherBC/BS PROVIDER NUMBER