Provider Demographics
NPI:1720544380
Name:CENTRAL FLORIDA DERMATOLOGY INSTITUTE, PLLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA DERMATOLOGY INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-553-5050
Mailing Address - Street 1:5450 LAND O LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-3413
Mailing Address - Country:US
Mailing Address - Phone:813-553-5050
Mailing Address - Fax:813-563-6353
Practice Address - Street 1:5450 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639
Practice Address - Country:US
Practice Address - Phone:813-553-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty