Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME0048473 | FL |
Y | 111NI0900X | Internist | ME0048473 | FL |
N | 207RA0401X | Internist - Addiction Medicine | ME48473 | FL |
NPI | 1235166851 |
---|---|
Provider Name | Ira Martin Fine |
First Address | Boynton Beach, FL 33437 |
Second Address | Boynton Beach, FL 33437-3535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 23/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E35981 | (02) | FL |