Provider Demographics
NPI:1952344863
Name:FINE, JAY B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:601 N FLAMINGO RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1015
Mailing Address - Country:US
Mailing Address - Phone:954-436-0244
Mailing Address - Fax:954-374-8855
Practice Address - Street 1:601 N FLAMINGO RD
Practice Address - Street 2:STE 403
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1015
Practice Address - Country:US
Practice Address - Phone:954-436-0244
Practice Address - Fax:954-374-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME25699208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL228876OtherAVMED
FL854177OtherAETNA
FL78422OtherBLUE CROSS & BLUE SHIELD
FLD584579Medicare UPIN
FL854177OtherAETNA