Provider Demographics
NPI:1417357922
Name:PREMIER DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:PREMIER DERMATOLOGY, LLC
Other - Org Name:PENNIE DERMATOLOGY & SKIN SURGERY CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-333-8887
Mailing Address - Street 1:3328 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7213
Mailing Address - Country:US
Mailing Address - Phone:941-474-8811
Mailing Address - Fax:
Practice Address - Street 1:900 PINE STREET 122 / 123
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34233-0000
Practice Address - Country:US
Practice Address - Phone:941-474-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty