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General NPI Number Information
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NPI Number | 1538479498
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Entity Type | Organization
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Legal Business Name | ROBERT WATINE MD LLC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 3390 TAMIAMI TRAIL STE 102
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952
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Country | US
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Telephone | 941-205-3034
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Fax | 941-637-5754
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Provider Business Mailing Address
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Address Line | PO BOX 512102
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City | PUNTA GORDA
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State | FL
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Zip | 33951
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Country | US
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Telephone | 941-205-3034
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Fax | 941-637-5754
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT WATINE
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Credential | MD
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Telephone | 941-205-3034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME51370
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License Number State | FL
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