Provider Demographics
NPI:1891094025
Name:SELBST, ALLAN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:MARTIN
Last Name:SELBST
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 1:1600 NW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4252
Mailing Address - Country:US
Mailing Address - Phone:954-849-3371
Mailing Address - Fax:954-370-7102
Practice Address - Street 1:1600 NW 99TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4252
Practice Address - Country:US
Practice Address - Phone:954-849-3371
Practice Address - Fax:954-370-7102
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36340207R00000X, 207RH0002X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine