Provider Demographics
NPI:1952590028
Name:IEZZI, ALAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOSEPH
Last Name:IEZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15511 N FLORIDA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1263
Mailing Address - Country:US
Mailing Address - Phone:813-908-8700
Mailing Address - Fax:813-908-7735
Practice Address - Street 1:15511 N FLORIDA AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1220
Practice Address - Country:US
Practice Address - Phone:813-963-3124
Practice Address - Fax:813-908-7735
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2011-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0046451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04237UMedicare PIN
FLD50965Medicare UPIN