MEDICARE: PREMIER ALLERGIST OF FLORIDA LLC

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	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1588439764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ALLERGIST OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	4975 PRESTON PARK BLVD STE 800
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5152
Country	:	US
Telephone Number	:	469-209-8355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 SAINT ANDREWS BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-2170
Country	:	US
Telephone Number	:	850-785-2717
Fax Number	:	850-785-2301

Authorized Official
Title or Position	:	VP RCM
Name	:	SAMUEL ALTMAN
Credential	:
Telephone Number	:	469-209-8355

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	11/17/2023

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