Provider Demographics
NPI:1619018561
Name:MID-FLORIDA DERMATOLOGY ASSOCIATES P.A.
Entity Type:Organization
Organization Name:MID-FLORIDA DERMATOLOGY ASSOCIATES P.A.
Other - Org Name:NOLA DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING DIR.
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-299-7333
Mailing Address - Street 1:7652 ASHLEY PARK CT
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6199
Mailing Address - Country:US
Mailing Address - Phone:407-299-7333
Mailing Address - Fax:407-293-2049
Practice Address - Street 1:7652 ASHLEY PARK CT
Practice Address - Street 2:SUITE 305
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6199
Practice Address - Country:US
Practice Address - Phone:407-299-7333
Practice Address - Fax:407-293-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty