Provider Demographics
NPI:1538479498
Name:ROBERT WATINE MD LLC
Entity Type:Organization
Organization Name:ROBERT WATINE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-205-3034
Mailing Address - Street 1:PO BOX 512102
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951
Mailing Address - Country:US
Mailing Address - Phone:941-205-3034
Mailing Address - Fax:941-637-5754
Practice Address - Street 1:3390 TAMIAMI TRAIL
Practice Address - Street 2:STE 102
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-205-3034
Practice Address - Fax:941-637-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty