=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174719579
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTINE BEHAN, M.D. PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 08/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14153 YOSEMITE DR STE 104
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-8065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-868-1943
-----------------------------------------------------
Fax | 727-819-1290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14153 YOSEMITE DR STE 104
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-8065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-868-1943
-----------------------------------------------------
Fax | 727-819-1290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | CHRISTINE M BEHAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 727-868-1943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME0064690
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------