Provider Demographics
NPI:1275538274
Name:ASSOCIATES IN MEDICAL AND SURGICAL DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:ASSOCIATES IN MEDICAL AND SURGICAL DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-598-4004
Mailing Address - Street 1:9125 CORSEA DEL FONTANA WAY
Mailing Address - Street 2:# 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4396
Mailing Address - Country:US
Mailing Address - Phone:239-598-4004
Mailing Address - Fax:239-598-4713
Practice Address - Street 1:9125 CORSEA DEL FONTANA WAY
Practice Address - Street 2:# 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4396
Practice Address - Country:US
Practice Address - Phone:239-598-4004
Practice Address - Fax:239-598-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42568OtherTUCKER BLUE CROSS #
FL04756OtherGOODMAN BLUE CROSS #
FL45192OtherGROUP BLUE CROSS #
FL04756OtherGOODMAN BLUE CROSS #
FLG54891Medicare UPIN
FL42568OtherTUCKER BLUE CROSS #
FLD61136Medicare UPIN
FL04756ZMedicare ID - Type UnspecifiedGOODMAN MEDICARE #