Provider Demographics
NPI:1073578449
Name:DERMATOLOGY INSTITUTE OF SOUTHWEST FLORIDA INC
Entity Type:Organization
Organization Name:DERMATOLOGY INSTITUTE OF SOUTHWEST FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-488-5300
Mailing Address - Street 1:1415 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3064
Mailing Address - Country:US
Mailing Address - Phone:941-488-5300
Mailing Address - Fax:941-412-1003
Practice Address - Street 1:1415 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3064
Practice Address - Country:US
Practice Address - Phone:941-488-5300
Practice Address - Fax:941-412-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID