Provider Demographics
NPI:1437633880
Name:DERMATOLOGY OF GAINESVILLE LLC
Entity Type:Organization
Organization Name:DERMATOLOGY OF GAINESVILLE LLC
Other - Org Name:DOGWOOD DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-2011
Mailing Address - Street 1:13575 NW 1ST LN STE 10
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3735
Mailing Address - Country:US
Mailing Address - Phone:352-260-0170
Mailing Address - Fax:352-559-3978
Practice Address - Street 1:13575 NW 1ST LN STE 10
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3735
Practice Address - Country:US
Practice Address - Phone:352-538-7821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty