Healthcare Provider Details

I. General information

NPI: 1275580185
Provider Name (Legal Business Name): ALAN E BAKST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE # 204
ATLANTIS FL
33462-6635
US

IV. Provider business mailing address

5401 S CONGRESS AVE STE 204
LAKE WORTH FL
33462-6637
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-4118
  • Fax: 561-967-3463
Mailing address:
  • Phone: 561-967-4118
  • Fax: 561-967-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036051310
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101255502
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME79475
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036051310
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2014-01915
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: