Provider Demographics
NPI:1518232065
Name:SCA DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:SCA DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S,
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-473-6750
Mailing Address - Street 1:1111 PARK CENTRE BLVD
Mailing Address - Street 2:S. 300
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5365
Mailing Address - Country:US
Mailing Address - Phone:305-623-5595
Mailing Address - Fax:
Practice Address - Street 1:915 W MONROE ST
Practice Address - Street 2:S. 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-1177
Practice Address - Country:US
Practice Address - Phone:904-903-4345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKIN AND CANCER ASSOCIATES, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-16
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty