Provider Demographics
NPI:1043385545
Name:FLORENCE DERMATOLOGY CLINIC P.A.
Entity Type:Organization
Organization Name:FLORENCE DERMATOLOGY CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-662-4524
Mailing Address - Street 1:309 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4726
Mailing Address - Country:US
Mailing Address - Phone:843-662-4524
Mailing Address - Fax:843-669-8073
Practice Address - Street 1:309 W PINE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4726
Practice Address - Country:US
Practice Address - Phone:843-662-4524
Practice Address - Fax:843-669-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCG0727OtherRAILROAD MEDICARE
SCCG0727OtherRAILROAD MEDICARE