Provider Demographics
NPI:1104006030
Name:NAPLES DERMATOLOGY PA
Entity Type:Organization
Organization Name:NAPLES DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-261-3082
Mailing Address - Street 1:4085 TAMIAMI TR N
Mailing Address - Street 2:SUITE B203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103
Mailing Address - Country:US
Mailing Address - Phone:239-261-3082
Mailing Address - Fax:239-261-1035
Practice Address - Street 1:4085 TAMIAMI TR N
Practice Address - Street 2:SUITE B203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103
Practice Address - Country:US
Practice Address - Phone:239-261-3082
Practice Address - Fax:239-261-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057073207N00000X
FLME0053679207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14961OtherBLUE CROSS
10442OtherBLUE CROSS
10442OtherBLUE CROSS
FLE96583Medicare UPIN