Provider Demographics
NPI:1205024304
Name:SKIN CANCER SPECIALIST, INC.
Entity Type:Organization
Organization Name:SKIN CANCER SPECIALIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-924-8080
Mailing Address - Street 1:5575 MARQUESAS CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3332
Mailing Address - Country:US
Mailing Address - Phone:941-924-8080
Mailing Address - Fax:941-924-8089
Practice Address - Street 1:5575 MARQUESAS CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3332
Practice Address - Country:US
Practice Address - Phone:941-924-8080
Practice Address - Fax:941-924-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81031207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00289190OtherRAILROAD MCR PIN
FLDE3824OtherRAILROAD MCR GROUP
FL51858YMedicare PIN
FLDE3824OtherRAILROAD MCR GROUP
FLC50386Medicare UPIN