Provider Demographics
NPI:1104675610
Name:ASTAPHAN, ADRIAN (MB BCH BAO)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:ASTAPHAN
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HCA FLORIDA LAWNWOOD HOSPITAL
Mailing Address - Street 2:1700 S 23RD STREET
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950
Mailing Address - Country:US
Mailing Address - Phone:772-468-4554
Mailing Address - Fax:
Practice Address - Street 1:HCA FLORIDA LAWNWOOD HOSPITAL
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-468-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program