Provider Demographics
NPI:1386727303
Name:ALTMAN, BRIAN JEFFERY (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JEFFERY
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18251 MERCHANTS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2300
Mailing Address - Country:US
Mailing Address - Phone:815-517-5981
Mailing Address - Fax:
Practice Address - Street 1:3923 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1085
Practice Address - Country:US
Practice Address - Phone:765-962-0521
Practice Address - Fax:765-962-1610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3818213E00000X
OH36-003468213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100354620AMedicaid
OH2529679Medicaid
U91343Medicare UPIN
OH2529679Medicaid
IN217060AMedicare PIN