Provider Demographics
NPI:1356582381
Name:ALLAN, BASSAN JORGE
Entity type:Individual
Prefix:MR
First Name:BASSAN
Middle Name:JORGE
Last Name:ALLAN
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:393-437-4002
Mailing Address - Fax:239-468-7942
Practice Address - Street 1:8925 COLONIAL CENTER DR STE 1000
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7813
Practice Address - Country:US
Practice Address - Phone:239-343-7400
Practice Address - Fax:239-468-7942
Is Sole Proprietor?:No
Enumeration Date:2009-03-21
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1111672086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025065300Medicaid