Healthcare Provider Details

I. General information

NPI: 1609994458
Provider Name (Legal Business Name): ALAN PAUL KOTERBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 US HIGHWAY 1 STE 235
NORTH PALM BEACH FL
33408-3835
US

IV. Provider business mailing address

840 US HIGHWAY 1 STE 235
NORTH PALM BEACH FL
33408-3835
US

V. Phone/Fax

Practice location:
  • Phone: 561-626-2006
  • Fax:
Mailing address:
  • Phone: 561-626-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301087873
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36121438
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME107004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: