Provider Demographics
NPI:1801392923
Name:CHRISTOS SKIN CANCER & MOHS CLINIC LLC
Entity Type:Organization
Organization Name:CHRISTOS SKIN CANCER & MOHS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-682-9329
Mailing Address - Street 1:4000 N STATE ROAD 7 STE 105
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4816
Mailing Address - Country:US
Mailing Address - Phone:954-682-9329
Mailing Address - Fax:954-541-2741
Practice Address - Street 1:4000 N STATE ROAD 7 STE 105
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-4816
Practice Address - Country:US
Practice Address - Phone:954-682-9329
Practice Address - Fax:954-541-2741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty