Provider Demographics
NPI:1558836445
Name:DOCTA LLC
Entity Type:Organization
Organization Name:DOCTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGEDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-444-8503
Mailing Address - Street 1:5200 S UNIVERSITY DR STE 102A
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5316
Mailing Address - Country:US
Mailing Address - Phone:754-444-8503
Mailing Address - Fax:561-907-4984
Practice Address - Street 1:5200 S UNIVERSITY DR STE 102A
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5316
Practice Address - Country:US
Practice Address - Phone:754-444-8503
Practice Address - Fax:561-907-4984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLOS H NOUSARI PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME88101OtherFLORIDA DEPARTMENT OF HEALTH
1477538940OtherNPPES