Provider Demographics
NPI:1437148996
Name:BAY DERMATOLOGY AND COSMETIC SURGERY P A
Entity Type:Organization
Organization Name:BAY DERMATOLOGY AND COSMETIC SURGERY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-841-8505
Mailing Address - Street 1:8220 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6639
Mailing Address - Country:US
Mailing Address - Phone:727-841-8505
Mailing Address - Fax:727-846-0561
Practice Address - Street 1:8220 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6639
Practice Address - Country:US
Practice Address - Phone:727-841-8505
Practice Address - Fax:727-846-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty