Provider Demographics
NPI:1598927386
Name:ALAN NETZMAN DO PA
Entity Type:Organization
Organization Name:ALAN NETZMAN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SAMBILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-852-9001
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070
Mailing Address - Country:US
Mailing Address - Phone:305-852-9001
Mailing Address - Fax:305-853-7060
Practice Address - Street 1:97671 OVERSEAS HIGHWAY
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037
Practice Address - Country:US
Practice Address - Phone:305-852-9001
Practice Address - Fax:305-853-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4620208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040023800Medicaid
FL1518026475OtherALAN A NETZMAN, DO PA - INDIVIDUAL
FL82785OtherBLUE CROSS BLUE SHIELD
FL040023800Medicaid
FL82785AMedicare PIN