Provider Demographics
NPI:1295842672
Name:DERMATOLOGY ASSOCIATES OF TALLAHASSEE PA
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF TALLAHASSEE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-877-4134
Mailing Address - Street 1:PO BOX 13859
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3859
Mailing Address - Country:US
Mailing Address - Phone:850-877-4134
Mailing Address - Fax:850-402-9130
Practice Address - Street 1:1707 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5317
Practice Address - Country:US
Practice Address - Phone:850-877-4134
Practice Address - Fax:850-402-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00415OtherBLUE CROSS BLUE SHEILD
FL00415Medicare UPIN