Provider Demographics
NPI:1407980105
Name:IRA MARTIN FINE MD PA
Entity Type:Organization
Organization Name:IRA MARTIN FINE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-375-8800
Mailing Address - Street 1:5329 ATLANTIC AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8142
Mailing Address - Country:US
Mailing Address - Phone:561-375-8800
Mailing Address - Fax:561-336-2202
Practice Address - Street 1:5329 ATLANTIC AVE STE 204
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8142
Practice Address - Country:US
Practice Address - Phone:561-375-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE35980Medicare UPIN
FLE0216Medicare ID - Type Unspecified