Provider Demographics
NPI:1447574694
Name:INTEGRATED DERMATOLOGY OF TAMARAC LLC
Entity Type:Organization
Organization Name:INTEGRATED DERMATOLOGY OF TAMARAC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-314-2000
Mailing Address - Street 1:902 CLINT MOORE RD
Mailing Address - Street 2:226
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2800
Mailing Address - Country:US
Mailing Address - Phone:561-314-2000
Mailing Address - Fax:
Practice Address - Street 1:7301 N UNIVERSITY DR
Practice Address - Street 2:102
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2919
Practice Address - Country:US
Practice Address - Phone:954-726-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty