Provider Demographics
NPI:1720543135
Name:FORT LAUDERDALE DERMATOLOGY, PLLC
Entity Type:Organization
Organization Name:FORT LAUDERDALE DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-546-3376
Mailing Address - Street 1:2021 E COMMERCIAL BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3754
Mailing Address - Country:US
Mailing Address - Phone:954-546-3376
Mailing Address - Fax:819-809-3748
Practice Address - Street 1:2021 E COMMERCIAL BLVD STE 301
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3754
Practice Address - Country:US
Practice Address - Phone:954-546-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty