Healthcare Provider Details

I. General information

NPI: 1144218223
Provider Name (Legal Business Name): ALAN B CLAUNCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2668
US

IV. Provider business mailing address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2668
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-6513
  • Fax: 239-574-0269
Mailing address:
  • Phone: 239-772-6513
  • Fax: 239-574-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101035993
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0025832
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME96436
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: