Provider Demographics
NPI:1124673983
Name:PHILIPSON, ALAN SAMUEL
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:SAMUEL
Last Name:PHILIPSON
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 1:3860 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3326
Mailing Address - Country:US
Mailing Address - Phone:954-290-0275
Mailing Address - Fax:954-678-9121
Practice Address - Street 1:3860 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3326
Practice Address - Country:US
Practice Address - Phone:954-290-0275
Practice Address - Fax:954-678-9121
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies