Provider Demographics
NPI:1235166851
Name:FINE, IRA MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:MARTIN
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 JOG ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:561-375-8800
Mailing Address - Fax:561-375-9497
Practice Address - Street 1:10075 JOG RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-375-8800
Practice Address - Fax:561-375-9497
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048473207R00000X
FLME48473207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE35981Medicare UPIN