Provider Demographics
NPI:1376687384
Name:DERMATOLOGY ASSOCIATES OF THE TREASURE COAST P A
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF THE TREASURE COAST P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:772-219-0044
Mailing Address - Street 1:809 SE OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2431
Mailing Address - Country:US
Mailing Address - Phone:772-219-0044
Mailing Address - Fax:772-219-0709
Practice Address - Street 1:809 SE OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2431
Practice Address - Country:US
Practice Address - Phone:772-219-0044
Practice Address - Fax:772-219-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069441207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG5451OtherPALMETTO-GBA
FL1255327722OtherINDIVIDUAL NPI
FL1255327722OtherINDIVIDUAL NPI
FLF85396Medicare UPIN