Provider Demographics
NPI:1619232501
Name:ALLIANT DERMATOLOGY PA
Entity Type:Organization
Organization Name:ALLIANT DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-883-9946
Mailing Address - Street 1:8620 E COUNTY ROAD 466
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3670
Mailing Address - Country:US
Mailing Address - Phone:352-399-7295
Mailing Address - Fax:352-399-7294
Practice Address - Street 1:8620 E COUNTY ROAD 466
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-3670
Practice Address - Country:US
Practice Address - Phone:352-399-7295
Practice Address - Fax:352-399-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 108772207N00000X
207ND0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQPF7TOtherBLUE CROSS BLUE SHIELD