Individual
DR. JACK A PINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 E HALLANDALE BEACH BLVD, SUITE PH-2, HALLANDALE BEACH, FL 33009-4834
(954) 456-6500
(954) 456-6503
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
ME 48050
FL
208800000X
Urology Physician
Primary
ME48050
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03807
BCBS FL
FL
01
—
11499
MEDICA
FL
01
—
18645
WELLCARE
FL
05
—
2730308 00
—
FL
01
—
4072125
AETNA PROVIDER #
FL
01
—
77215
MEDICARE GROUP
FL
01
—
P0003143
FLORIDA HEALTHCARE PLUS
FL
01
—
P00470777
RR MEDICARE
FL
01
—
QMP000003703988
MOLINA
FL
Enumeration date
04/19/2006
Last updated
04/10/2017
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