Basic Information
| Provider Information | |||||||||
| NPI: | 1962545533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FINE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 VIRGINIA ST | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344000 | ||||||||
| FaxNumber: | 7277385037 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 CORAL HILLS DR | ||||||||
| Address2: | #302 | ||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549743320 | ||||||||
| FaxNumber: | 9549743320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 11/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0063855 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BF3498385 | 01 | FL | DEA NUMBER | OTHER | 373876100 | 05 | FL | MEDICAID | ME0063855 | 01 | FL | MEDICAL LICENSE | OTHER |