Healthcare Provider Details

I. General information

NPI: 1720094162
Provider Name (Legal Business Name): ALAN I. SACKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 TRINITY DR
PENSACOLA FL
32504-5708
US

IV. Provider business mailing address

PO BOX 2699 ATTN: SHMG/HPE
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-1575
  • Fax: 850-416-7435
Mailing address:
  • Phone: 850-416-1575
  • Fax: 850-416-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME79325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: