MEDICARE: DENNIS THOMAS ALTER MD

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	174400000X	Specialist	ME0054825	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200014378	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659375152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS THOMAS ALTER MD

Provider Business Mailing Address
First Line	:	21 HOSPITAL DR
Second Line	:	STE 110
City	:	PALM COAST
State	:	FL
Zip	:	32164-2380
Country	:	US
Telephone Number	:	386-586-1370
Fax Number	:	386-586-1369

Provider Business Practice Location Address
First Line	:	21 HOSPITAL DRIVE
Second Line	:	STE. 110
City	:	PALM COAST
State	:	FL
Zip	:	32164-8683
Country	:	US
Telephone Number	:	386-586-1370
Fax Number	:	386-586-1369

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/23/2008

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