Healthcare Provider Details

I. General information

NPI: 1174503379
Provider Name (Legal Business Name): RAND W. ALTEMOSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6214
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIAL DEPARTMENT
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-3950
  • Fax: 813-876-0432
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME39676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: