Provider Demographics
NPI:1174719579
Name:CHRISTINE BEHAN, M.D. PA
Entity type:Organization
Organization Name:CHRISTINE BEHAN, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-868-1943
Mailing Address - Street 1:14153 YOSEMITE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8065
Mailing Address - Country:US
Mailing Address - Phone:727-868-1943
Mailing Address - Fax:727-819-1290
Practice Address - Street 1:14153 YOSEMITE DR STE 104
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8065
Practice Address - Country:US
Practice Address - Phone:727-868-1943
Practice Address - Fax:727-819-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064690261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110165061OtherRAILROAD MEDICARE
FL110165061OtherRAILROAD MEDICARE