Provider Demographics
NPI:1215120100
Name:ALTENBURG, JOHN F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:ALTENBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 WEBB RD
Mailing Address - Street 2:SUITE #205
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2872
Mailing Address - Country:US
Mailing Address - Phone:813-884-2020
Mailing Address - Fax:813-884-4429
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:SUITE #205
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-884-2020
Practice Address - Fax:813-884-4429
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0035287207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85518Medicare UPIN
30300ZMedicare PIN
FL30300AMedicare PIN
30300Medicare PIN