MEDICARE: ALAN SAMUEL PHILIPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		FL

General Provider Information

NPI Number	:	1124673983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN SAMUEL PHILIPSON

Provider Business Mailing Address
First Line	:	3860 W COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3326
Country	:	US
Telephone Number	:	954-290-0275
Fax Number	:	954-678-9121

Provider Business Practice Location Address
First Line	:	3860 W COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3326
Country	:	US
Telephone Number	:	954-290-0275
Fax Number	:	954-678-9121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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