Provider Demographics
NPI:1003111923
Name:ADVANCED FACIAL COSMETIC & LASER SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED FACIAL COSMETIC & LASER SURGERY CENTER, LLC
Other - Org Name:OCEAN DRIVE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-234-3700
Mailing Address - Street 1:5070 HIGHWAY A1A
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1400
Mailing Address - Country:US
Mailing Address - Phone:772-234-3700
Mailing Address - Fax:772-234-3770
Practice Address - Street 1:5070 HIGHWAY A1A
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1400
Practice Address - Country:US
Practice Address - Phone:772-234-3700
Practice Address - Fax:772-234-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207ND0101X, 208200000X, 208600000X, 2086X0206X
FLME99004208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty