Provider Demographics
NPI:1326144817
Name:LIFTON, ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:LIFTON
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 1:200 CAPRI ISLES BLVD
Mailing Address - Street 2:SUITE 7D
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-5350
Mailing Address - Country:US
Mailing Address - Phone:941-485-2220
Mailing Address - Fax:941-485-2150
Practice Address - Street 1:200 CAPRI ISLES BLVD
Practice Address - Street 2:SUITE 7D
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-5350
Practice Address - Country:US
Practice Address - Phone:941-485-2220
Practice Address - Fax:941-485-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00733052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41439OtherBLUE SHIELD
FL41439Medicare ID - Type Unspecified
FL41439OtherBLUE SHIELD