Provider Demographics
NPI:1629186523
Name:DERMATOLOGY CONSULTANTS OF S FL PA
Entity Type:Organization
Organization Name:DERMATOLOGY CONSULTANTS OF S FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-752-2630
Mailing Address - Street 1:3000 N UNIVERSITY DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5055
Mailing Address - Country:US
Mailing Address - Phone:954-752-2630
Mailing Address - Fax:954-755-1865
Practice Address - Street 1:3000 N UNIVERSITY DR
Practice Address - Street 2:SUITE K
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5055
Practice Address - Country:US
Practice Address - Phone:954-752-2630
Practice Address - Fax:954-755-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-11-27
Deactivation Date:2007-01-30
Deactivation Code:
Reactivation Date:2007-02-26
Provider Licenses
StateLicense IDTaxonomies
FLMP36624207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99554OtherMEDICARE PTAN