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General NPI Number Information
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NPI Number | 1265628861
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Entity Type | Organization
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Legal Business Name | ALLAN BIRNBAUM DO PA
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 1701 SE HILLMOOR DR SUITE 5
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7552
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Country | US
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Telephone | 772-337-7320
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Fax | 772-337-7321
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Provider Business Mailing Address
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Address Line | 1701 SE HILLMOOR DR SUITE 5
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7552
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Country | US
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Telephone | 772-337-7320
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Fax | 772-337-7321
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. ROBERT C FOLLMER
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Credential |
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Telephone | 772-337-7320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME124391
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS4258
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License Number State | FL
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