Provider Demographics
NPI:1376867390
Name:ARNOLD ISON MD CHARTERED
Entity Type:Organization
Organization Name:ARNOLD ISON MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:ISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-347-7524
Mailing Address - Street 1:1609 PASADENA AVE S
Mailing Address - Street 2:2K
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4565
Mailing Address - Country:US
Mailing Address - Phone:727-347-7524
Mailing Address - Fax:727-384-6336
Practice Address - Street 1:1609 PASADENA AVE S
Practice Address - Street 2:2K
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4565
Practice Address - Country:US
Practice Address - Phone:727-347-7524
Practice Address - Fax:727-384-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0012316207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FMD58082Medicare UPIN