=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467487967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE LARAMEE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 08/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1180 PONCE DE LEON BLVD STE 401 JSA PONCE DE LEON BLVD PRIMARY CARE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756-1014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-581-3171
-----------------------------------------------------
Fax | 727-447-4827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10051 5TH STREET NORTH #200 JSA HEALTHCARE CORP
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33702-2211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-828-8930
-----------------------------------------------------
Fax | 727-568-6011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME69487
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------