Provider Demographics
NPI:1598842684
Name:MOSTOV, ALAN LEE (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:LEE
Last Name:MOSTOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 770719
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-0179
Mailing Address - Country:US
Mailing Address - Phone:352-873-4458
Mailing Address - Fax:352-873-8116
Practice Address - Street 1:7860 SW 103RD STREET RD
Practice Address - Street 2:BLDG 100 SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-8623
Practice Address - Country:US
Practice Address - Phone:352-873-4458
Practice Address - Fax:352-873-8116
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0S0003054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82421OtherBCBS
FLP00140261OtherRR MEDICARE
82421XMedicare PIN
FLP00140261OtherRR MEDICARE