Provider Demographics
NPI:1558339580
Name:VENNOS, ALEXANDER N (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:N
Last Name:VENNOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:N
Other - Last Name:VENNOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 KNUTH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4629
Mailing Address - Country:US
Mailing Address - Phone:561-736-1200
Mailing Address - Fax:561-742-1919
Practice Address - Street 1:1800 SE TIFFANY AVE
Practice Address - Street 2:ATTENTION RHONDA ROBERTSON RADIOLOGY DEPT
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7521
Practice Address - Country:US
Practice Address - Phone:561-736-1200
Practice Address - Fax:561-742-1919
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME548142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22486Medicare UPIN