| Entity Name: | ROBERT P. FEDOR, D.O. P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 21 Jul 1982 (43 years ago) |
| Date of dissolution: | 26 Jan 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 26 Jan 2022 (3 years ago) |
| Document Number: | F91623 |
| FEI/EIN Number | 59-2202414 |
| Address: | 1811 Shore Drive South, South Pasadena, FL 33707 |
| Mail Address: | 1811 shore drive south, Florida, FL 33707 |
| ZIP code: | 33707 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073633665 | 2007-03-29 | 2018-06-20 | 1811 SHORE DR S, SOUTH PASADENA, FL, 337074701, US | 1811 SHORE DR S, SOUTH PASADENA, FL, 337074701, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-391-4100 |
| Fax | 7273982067 |
Authorized person
| Name | EHREN CARINE |
| Role | DO |
| Phone | 7273914100 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS ID # DR. BACON |
| Number | 14H46 |
| State | FL |
| Issuer | BCBS GROUP # |
| Number | 002CM |
| State | FL |
| Issuer | BCBS ID # DR. CARINE |
| Number | 3TQES |
| State | FL |
| Issuer | BCBS PROVIDER # |
| Number | 82398 |
| State | FL |
| Issuer | MEDICAL LICENSE |
| Number | OS12209 |
| State | FL |
| Issuer | MEDICAL LICENSE |
| Number | OS10824 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| carine, ehren | Agent | 1811 Shore Drive South, South Pasadena, FL 33707 |
| Name | Role | Address |
|---|---|---|
| carine, ehren T | President | 1811 Shore Drive South, S. Pasadena, FL 33707 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-01-26 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-04 | 1811 Shore Drive South, South Pasadena, FL 33707 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-04 | carine, ehren | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-16 | 1811 Shore Drive South, South Pasadena, FL 33707 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-16 | 1811 Shore Drive South, South Pasadena, FL 33707 | No data |
| CANCEL ADM DISS/REV | 2008-12-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2006-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-01-26 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-10 |
| ANNUAL REPORT | 2019-02-04 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-02-07 |
| ANNUAL REPORT | 2016-04-24 |
| ANNUAL REPORT | 2015-04-28 |
| ANNUAL REPORT | 2014-04-22 |
| ANNUAL REPORT | 2013-02-04 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
