Provider Demographics
NPI:1689746356
Name:ALTMAN, ANDREW ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROBERT
Last Name:ALTMAN
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 1:1121 MARBLE WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3014
Mailing Address - Country:US
Mailing Address - Phone:954-850-7871
Mailing Address - Fax:
Practice Address - Street 1:137 NW 100 AVENUE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-577-5161
Practice Address - Fax:954-577-5191
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51770174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME51770OtherMEDICAL LICENSE
FL047951900Medicaid
FL047951900Medicaid
FLME51770OtherMEDICAL LICENSE
FL05801ZMedicare PIN