Provider Demographics
NPI:1497443675
Name:OCEAN DERMATOLOGY LLC
Entity Type:Organization
Organization Name:OCEAN DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:HOUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-373-9416
Mailing Address - Street 1:1739 B RD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4221
Mailing Address - Country:US
Mailing Address - Phone:561-373-9416
Mailing Address - Fax:
Practice Address - Street 1:2515 S STATE ROAD 7 STE 200
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9334
Practice Address - Country:US
Practice Address - Phone:561-694-5800
Practice Address - Fax:561-694-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty