Basic Information
| Provider Information | |||||||||
| NPI: | 1811484751 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOCTORS INN ONE INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | CARINE FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 NORTHSIDE DR | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337612236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274990356 | ||||||||
| FaxNumber: | 7277813312 | ||||||||
| Practice Location | |||||||||
| Address1: | 1811 SHORE DR S | ||||||||
| Address2: | |||||||||
| City: | S PASADENA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273914100 | ||||||||
| FaxNumber: | 7273982067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2018 | ||||||||
| LastUpdateDate: | 07/12/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARINE | ||||||||
| AuthorizedOfficialFirstName: | EHREN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7273914100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.