Provider Demographics
NPI:1770547077
Name:ALABATA, PHIL (DO)
Entity type:Individual
Prefix:DR
First Name:PHIL
Middle Name:
Last Name:ALABATA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 REDSTONE AVE W
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6465
Mailing Address - Country:US
Mailing Address - Phone:850-331-3937
Mailing Address - Fax:850-634-6136
Practice Address - Street 1:239 REDSTONE AVE W
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-6465
Practice Address - Country:US
Practice Address - Phone:850-331-3937
Practice Address - Fax:850-634-6136
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9285207W00000X, 207WX0009X, 207WX0009X
ALDO.1631207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18BDGFFMedicare ID - Type Unspecified
FLH86186Medicare UPIN