Provider Demographics
NPI:1285834416
Name:HOLLYWOOD DERMATOLOGY AND COSMETIC SURGERY SPECIALISTS PLLC
Entity Type:Organization
Organization Name:HOLLYWOOD DERMATOLOGY AND COSMETIC SURGERY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-961-1200
Mailing Address - Street 1:3850 HOLLYWOOD BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6745
Mailing Address - Country:US
Mailing Address - Phone:954-961-1200
Mailing Address - Fax:954-963-0378
Practice Address - Street 1:3850 HOLLYWOOD BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6745
Practice Address - Country:US
Practice Address - Phone:954-961-1200
Practice Address - Fax:954-963-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty