Provider Demographics
NPI:1821323775
Name:FAMILY DERMATOLOGY, PL
Entity Type:Organization
Organization Name:FAMILY DERMATOLOGY, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-918-1900
Mailing Address - Street 1:929 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9241
Mailing Address - Country:US
Mailing Address - Phone:941-918-1900
Mailing Address - Fax:
Practice Address - Street 1:929 S TAMIAMI TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9239
Practice Address - Country:US
Practice Address - Phone:941-918-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-10
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty