Provider Demographics
NPI:1659375152
Name:ALTER, DENNIS THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:THOMAS
Last Name:ALTER
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 1:21 HOSPITAL DR
Mailing Address - Street 2:STE 110
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2380
Mailing Address - Country:US
Mailing Address - Phone:386-586-1370
Mailing Address - Fax:386-586-1369
Practice Address - Street 1:21 HOSPITAL DRIVE
Practice Address - Street 2:STE. 110
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8683
Practice Address - Country:US
Practice Address - Phone:386-586-1370
Practice Address - Fax:386-586-1369
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA200014378OtherRAILROAD MEDICARE
FL370314200Medicaid
FL17768Medicare ID - Type UnspecifiedMEDICARE
FL370314200Medicaid