MEDICARE: DR. ALLAN JAY BIRNBAUM D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS4258	FL

General Provider Information

NPI Number	:	1073549358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN JAY BIRNBAUM D.O.

Provider Business Mailing Address
First Line	:	1701 SE HILLMOOR DR
Second Line	:	SUITE #5
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7552
Country	:	US
Telephone Number	:	772-485-7507
Fax Number	:	772-398-9505

Provider Business Practice Location Address
First Line	:	1701 SE HILLMOOR DR
Second Line	:	SUITE #5
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7552
Country	:	US
Telephone Number	:	772-485-7507
Fax Number	:	772-398-9505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	03/20/2014

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