Provider Demographics
NPI:1821501156
Name:ALEXANDER, PHILIPPE
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6365 NW REGAL CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-5358
Mailing Address - Country:US
Mailing Address - Phone:772-370-4639
Mailing Address - Fax:772-370-4639
Practice Address - Street 1:6365 NW REGAL CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-5358
Practice Address - Country:US
Practice Address - Phone:772-370-4639
Practice Address - Fax:772-370-4639
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities