Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | ME 48050 | FL |
Y | 208800000X | Urologist | ME48050 | FL |
NPI | 1285699447 |
---|---|
Provider Name | Dr. Jack A Pines |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Hallandale Beach, FL 33009-4834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 10/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03807 | BCBS FL (01) | FL |
11499 | MEDICA (01) | FL |
18645 | WELLCARE (01) | FL |
2730308 00 | (05) | FL |
4072125 | AETNA PROVIDER # (01) | FL |
77215 | MEDICARE GROUP (01) | FL |
D50837 | (02) | FL |
P0003143 | FLORIDA HEALTHCARE PLUS (01) | FL |
P00470777 | RR MEDICARE (01) | FL |
QMP000003703988 | MOLINA (01) | FL |