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General NPI Number Information
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NPI Number | 1255775805
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Entity Type | Individual
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Provider Name | ALEXANDER SASHA RACKMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 880 NW 13TH ST
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City | BOCA RATON
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State | FL
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Zip | 33486-2342
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Country | US
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Telephone | 561-566-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 880 NW 13TH ST
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City | BOCA RATON
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State | FL
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Zip | 33486-2342
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Country | US
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Telephone | 561-566-5328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036140524
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME155094
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MTL-2017-075
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License Number State | GU
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