Provider Demographics
NPI:1407943426
Name:ALLEN H BEZNER MD PA
Entity Type:Organization
Organization Name:ALLEN H BEZNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-439-1234
Mailing Address - Street 1:116 JFK DR
Mailing Address - Street 2:BLDG 110
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6606
Mailing Address - Country:US
Mailing Address - Phone:561-439-1234
Mailing Address - Fax:561-439-0506
Practice Address - Street 1:116 JFK DR
Practice Address - Street 2:BLDG 110
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6606
Practice Address - Country:US
Practice Address - Phone:561-439-1234
Practice Address - Fax:561-439-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38678174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02977OtherWELLCARE/HEALTHEASE
FL5945OtherNEIGHBORHOOD HEALTH PLAN
FL1003492OtherCAREPLUS
FL071095OtherAV MED
FL4099722OtherAETNA
FL5945OtherNEIGHBORHOOD HEALTH PLAN
FL96393Medicare ID - Type Unspecified
FL02977OtherWELLCARE/HEALTHEASE