Provider Demographics
NPI:1902885270
Name:ALAN L TANNENBAUM MD PA
Entity Type:Organization
Organization Name:ALAN L TANNENBAUM MD PA
Other - Org Name:PRIMARY CARE ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRIMARY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-549-2772
Mailing Address - Street 1:523 CAPE CORAL PKWY E
Mailing Address - Street 2:PRIMARY CARE ASSOC
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8545
Mailing Address - Country:US
Mailing Address - Phone:239-549-2772
Mailing Address - Fax:239-549-2332
Practice Address - Street 1:523 CAPE CORAL PKWY E
Practice Address - Street 2:PRIMARY CARE ASSOC
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8545
Practice Address - Country:US
Practice Address - Phone:239-549-2772
Practice Address - Fax:239-549-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38626OtherBS
FL38626OtherBS