Provider Demographics
NPI:1689697815
Name:DERMATOLOGY & DERMASURGERY OF NAPLES PA
Entity Type:Organization
Organization Name:DERMATOLOGY & DERMASURGERY OF NAPLES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:WALTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-434-0303
Mailing Address - Street 1:1108 GOODLETTE RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5451
Mailing Address - Country:US
Mailing Address - Phone:239-434-0303
Mailing Address - Fax:239-262-8730
Practice Address - Street 1:1108 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5451
Practice Address - Country:US
Practice Address - Phone:239-434-0303
Practice Address - Fax:239-262-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG71238Medicare UPIN