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General NPI Number Information
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NPI Number | 1386727303
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Entity Type | Individual
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Provider Name | BRIAN JEFFERY ALTMAN DPM
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 3923 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1085
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Country | US
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Telephone | 765-962-0521
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Fax | 765-962-1610
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Provider Business Mailing Address
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Address Line | 18251 MERCHANTS AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-2300
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Country | US
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Telephone | 815-517-5981
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO3818
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License Number State | FL
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