MEDICARE: DR. MICHAEL ALAN ARCHER M.D.

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	ME-0038568	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04056	OTHER	FL	INSURANCE PROVIDER NUMBER

General Provider Information

NPI Number	:	1902950108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ALAN ARCHER M.D.

Provider Business Mailing Address
First Line	:	907 MAR WALT DR
Second Line	:	SUITE 2012
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6960
Country	:	US
Telephone Number	:	850-863-1447
Fax Number	:	850-863-5350

Provider Business Practice Location Address
First Line	:	907 MAR WALT DR
Second Line	:	SUITE 2012
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6960
Country	:	US
Telephone Number	:	850-863-1447
Fax Number	:	850-863-5350

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/09/2007

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