Individual
ANTHONY RICHARD PINE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2776 CLEVELAND AVE, FORT MYERS, FL 33901-5855
(239) 343-2606
(239) 343-3695
Mailing address
P.O. BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-2606
(239) 343-3695
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9101826
FL
363AM0700X
Medical Physician Assistant
PA9101826
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291154000
—
FL
Enumeration date
12/05/2005
Last updated
04/05/2021
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