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  5. LEE D. ETTINGER, M.D., P.A.

LEE D. ETTINGER, M.D., P.A. - Florida Company Profile

Company Details

Entity Name: LEE D. ETTINGER, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

LEE D. ETTINGER, M.D., P.A. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 03 Jul 1984 (41 years ago)
Date of dissolution: 04 Jan 2024 (a year ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 04 Jan 2024 (a year ago)
Document Number: H10698
FEI/EIN Number 592427256

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 9664 Pebble Beach Way, Tallahassee, FL, 32312, US
Mail Address: PO BOX 254152, Patrick AFB, FL, 32925, US
ZIP code: 32312
County: Leon
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1356482103 2007-02-12 2018-08-20 PO BOX 792, SHALIMAR, FL, 325790792, US 914 MAR WALT DR # C, FORT WALTON BEACH, FL, 32547, US

Contacts
Phone +1 850-863-3199
Fax 8508633196

Authorized person
Name CHRISTIE BENOIT
Role MANAGER
Phone 8509747120

Taxonomy
Taxonomy Code 207RP1001X - Pulmonary Disease Physician
License Number ME35386
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 067872400
State FL
Issuer MEDICARE RAILROAD
Number 110007848
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LEE D. ETTINGER, M. D. , P. A. PROFIT SHARING 2017 592427256 2018-12-12 LEE D. ETTINGER, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2018-12-12
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2017 592427256 2018-10-04 LEE D. ETTINGER, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2018-10-04
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2016 592427256 2017-06-27 LEE D. ETTINGER, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2017-06-27
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2015 592427256 2016-07-25 LEE D. ETTINGER, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2016-07-25
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2014 592427256 2015-07-10 LEE D. ETTINGER, M.D., P.A. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2015-07-10
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2013 592427256 2014-07-03 LEE D. ETTINGER, M.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2014-07-03
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2012 592427256 2013-06-24 LEE D. ETTINGER, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Signature of
Role Plan administrator
Date 2013-06-24
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2011 592296196 2012-07-16 LEE D. ETTINGER, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Plan administrator’s name and address
Administrator’s EIN 592296196
Plan administrator’s name LEE D. ETTINGER, M.D., P.A.
Plan administrator’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547
Administrator’s telephone number 8508633199

Signature of
Role Plan administrator
Date 2012-07-16
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2010 592427256 2011-09-02 LEE D. ETTINGER, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Plan administrator’s name and address
Administrator’s EIN 592427256
Plan administrator’s name LEE D. ETTINGER, M.D., P.A.
Plan administrator’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547
Administrator’s telephone number 8508633199

Signature of
Role Plan administrator
Date 2011-09-02
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature
LEE D. ETTINGER, M.D., P.A. PROFIT SHARING PLAN AND TRUST 2009 592296196 2010-09-07 LEE D. ETTINGER, M.D., P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1986-07-01
Business code 621111
Sponsor’s telephone number 8508633199
Plan sponsor’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547

Plan administrator’s name and address
Administrator’s EIN 592296196
Plan administrator’s name LEE D. ETTINGER, M.D., P.A.
Plan administrator’s address 914-C MAR WALT DRIVE, FORT WALTON BEACH, FL, 32547
Administrator’s telephone number 8508633199

Signature of
Role Plan administrator
Date 2010-09-07
Name of individual signing LEE D. ETTINGER, M.D.
Valid signature Filed with authorized/valid electronic signature

Key Officers & Management

Name Role Address
ETTINGER, LEE D Director 9664 Pebble Beach Way, Tallahassee, FL, 32312
ETTINGER, LEE D., M.D. Agent 9664 Pebble Beach Way, Tallahassee, FL, 32312

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2024-01-04 - -
CHANGE OF MAILING ADDRESS 2021-02-02 9664 Pebble Beach Way, Tallahassee, FL 32312 -
CHANGE OF PRINCIPAL ADDRESS 2020-01-24 9664 Pebble Beach Way, Tallahassee, FL 32312 -
REGISTERED AGENT ADDRESS CHANGED 2020-01-24 9664 Pebble Beach Way, Tallahassee, FL 32312 -
CANCEL ADM DISS/REV 2004-11-05 - -
ADMIN DISSOLUTION FOR ANNUAL REPORT 2004-10-01 - -

Documents

Name Date
VOLUNTARY DISSOLUTION 2024-01-04
ANNUAL REPORT 2023-02-08
ANNUAL REPORT 2022-03-01
ANNUAL REPORT 2021-02-02
ANNUAL REPORT 2020-01-24
ANNUAL REPORT 2019-03-04
ANNUAL REPORT 2018-03-05
ANNUAL REPORT 2017-02-13
ANNUAL REPORT 2016-03-28
ANNUAL REPORT 2015-03-30

Companies related by officers

No other companies in our directory share the same officers as LEE D. ETTINGER, M.D., P.A.

Companies related by address

No other companies in our directory share the same address as LEE D. ETTINGER, M.D., P.A.

Date of last update: 03 Apr 2025

Sources: Florida Department of State

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