Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME69377 | FL |
NPI | 1013097427 |
---|---|
Provider Name | Dr. Andrew David Fine |
First Address | Sarasota, FL 34233 |
Second Address | Sarasota, FL 34233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 18/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
262554700 | (05) | FL |
58986 | BCBS (01) | |
7135247 | AETNA (01) | |
H43031 | (02) |