Provider Demographics
NPI:1265454920
Name:OBREGON, ALAN VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:VICTOR
Last Name:OBREGON
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:13813 METRO PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4343
Practice Address - Country:US
Practice Address - Phone:239-938-1717
Practice Address - Fax:239-985-9634
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235653207Q00000X
FLME95446207Q00000X
SC23229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY368AS1OtherEMPIRE BCBS
FL08239OtherBCBS
NY11513660OtherCAQH
FL279815800Medicaid
FL08239OtherBCBS
NY11513660OtherCAQH
I46882Medicare UPIN