Provider Demographics
NPI:1164759478
Name:WESTON DERMATOLOGY LLC
Entity Type:Organization
Organization Name:WESTON DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:STERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-384-6262
Mailing Address - Street 1:1040 WESTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1978
Mailing Address - Country:US
Mailing Address - Phone:954-384-6262
Mailing Address - Fax:954-384-1202
Practice Address - Street 1:1040 WESTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1978
Practice Address - Country:US
Practice Address - Phone:954-384-6262
Practice Address - Fax:954-384-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60178207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15125Medicare UPIN