Healthcare Provider Details

I. General information

NPI: 1215926373
Provider Name (Legal Business Name): AMARIN ALEXANDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S HICKORY ST HOLMES REGIONAL MEDICAL CENTER
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

4801 SOLITARY DR
ROCKLEDGE FL
32955-6554
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-1771
  • Fax: 321-434-1774
Mailing address:
  • Phone: 321-434-4600
  • Fax: 321-434-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME83127
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME83127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: