Provider Demographics
NPI:1508129214
Name:CHARLES, ALAN SHIFMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SHIFMAN
Last Name:CHARLES
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 1:2615 SW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6162
Mailing Address - Country:US
Mailing Address - Phone:239-542-7057
Mailing Address - Fax:
Practice Address - Street 1:741 GATEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1029
Practice Address - Country:US
Practice Address - Phone:478-804-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG019864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG019864OtherMEDICAL LICENSE