Provider Demographics
NPI:1669653473
Name:IOANNIDES AND SANDERS DERMATOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:IOANNIDES AND SANDERS DERMATOLOGY ASSOCIATES LLC
Other - Org Name:TREASURE COAST DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:IOANNIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-878-3376
Mailing Address - Street 1:140 SW CHAMBER CT
Mailing Address - Street 2:200
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3414
Mailing Address - Country:US
Mailing Address - Phone:772-878-3376
Mailing Address - Fax:772-879-9970
Practice Address - Street 1:140 SW CHAMBER CT
Practice Address - Street 2:200
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3414
Practice Address - Country:US
Practice Address - Phone:772-878-3376
Practice Address - Fax:772-879-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty