Provider Demographics
NPI:1669468625
Name:COUSIN, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:COUSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10010 N DALE MABRY HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4469
Mailing Address - Country:US
Mailing Address - Phone:813-964-8439
Mailing Address - Fax:813-964-0908
Practice Address - Street 1:10010 N DALE MABRY HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4469
Practice Address - Country:US
Practice Address - Phone:813-964-8439
Practice Address - Fax:813-964-0908
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME566902085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09624Medicare PIN