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General NPI Number Information
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NPI Number | 1558339580
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Entity Type | Individual
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Provider Name | ALEXANDER N VENNOS MD
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 1800 SE TIFFANY AVE ATTENTION RHONDA ROBERTSON RADIOLOGY DEPT
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-7521
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Country | US
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Telephone | 561-736-1200
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Fax | 561-742-1919
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Provider Business Mailing Address
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Address Line | 200 KNUTH RD SUITE 200
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4629
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Country | US
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Telephone | 561-736-1200
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Fax | 561-742-1919
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME54814
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License Number State | FL
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