Healthcare Provider Details

I. General information

NPI: 1437680949
Provider Name (Legal Business Name): ALEXANDER HERBST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2866 TAMIAMI TRL STE A
PORT CHARLOTTE FL
33952-5165
US

IV. Provider business mailing address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

V. Phone/Fax

Practice location:
  • Phone: 941-764-1055
  • Fax: 941-764-7984
Mailing address:
  • Phone: 561-548-1273
  • Fax: 561-548-1572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME151185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: