Provider Demographics
NPI:1164875936
Name:SKIN CANCER CENTER OF NAPLES LLC
Entity Type:Organization
Organization Name:SKIN CANCER CENTER OF NAPLES LLC
Other - Org Name:SKIN CANCER CENTER OF BONITA SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-661-4300
Mailing Address - Street 1:29170 POSITANO LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-2851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26800 S TAMIAMI TRL
Practice Address - Street 2:SUITE 360
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
Practice Address - Country:US
Practice Address - Phone:239-495-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9361941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty