Provider Demographics
NPI:1932329653
Name:DENNIS T ALTER MD PA
Entity Type:Organization
Organization Name:DENNIS T ALTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-586-1370
Mailing Address - Street 1:21 HOSPITAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2380
Mailing Address - Country:US
Mailing Address - Phone:386-586-1370
Mailing Address - Fax:386-586-1369
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2380
Practice Address - Country:US
Practice Address - Phone:386-586-1370
Practice Address - Fax:386-586-1369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENNIS T ALTER MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACE8874OtherRAILROAD MEDICARE
FL254768600Medicaid
GACE8874OtherRAILROAD MEDICARE
FL254768600Medicaid