Provider Demographics
NPI:1710902812
Name:MARUMOTO, ALAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:K
Last Name:MARUMOTO
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:PO BOX 9137
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-9137
Mailing Address - Country:US
Mailing Address - Phone:321-726-3855
Mailing Address - Fax:321-775-7101
Practice Address - Street 1:1800 W. HIBISCUS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2629
Practice Address - Country:US
Practice Address - Phone:321-726-3855
Practice Address - Fax:321-775-7101
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA646792085R0202X
FLME857982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646790OtherMEDICAL
CA00A646790OtherMEDICAL
CAWA64679AMedicare ID - Type Unspecified
FL64679AMedicare PIN