Provider Demographics
NPI:1316050115
Name:KLINE, JUDITH ELLEN (DO)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELLEN
Last Name:KLINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 94 AVE N
Mailing Address - Street 2:#201
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:727-577-0981
Mailing Address - Fax:727-576-4166
Practice Address - Street 1:750 94 AVE N
Practice Address - Street 2:#201
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702
Practice Address - Country:US
Practice Address - Phone:727-577-0981
Practice Address - Fax:727-576-4166
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS1738208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
81612OtherBCBS
81612OtherBCBS