Provider Demographics
NPI:1174563449
Name:STINE, MARK C (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:STINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13787 BELCHER RD S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4065
Mailing Address - Country:US
Mailing Address - Phone:727-535-9899
Mailing Address - Fax:727-535-2818
Practice Address - Street 1:13787 BELCHER RD S
Practice Address - Street 2:SUITE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4065
Practice Address - Country:US
Practice Address - Phone:727-535-9899
Practice Address - Fax:727-535-2818
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372049700Medicaid
FL80756Medicare ID - Type Unspecified
FL372049700Medicaid