Provider Demographics
NPI:1558448522
Name:CENTER FOR DERMATOLOGY AND SKIN SURGERY INC
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGY AND SKIN SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:AL
Authorized Official - Last Name:PROPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-977-3600
Mailing Address - Street 1:14521 UNIVERSITY POINT PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-5424
Mailing Address - Country:US
Mailing Address - Phone:813-977-3600
Mailing Address - Fax:
Practice Address - Street 1:14521 UNIVERSITY POINT PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5424
Practice Address - Country:US
Practice Address - Phone:813-977-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72962OtherBLUE CROSS BLUE SHIELD
FL205596OtherAVMED
FLCG5355OtherRAILROAD MEDICARE
FLK1607Medicare PIN