Provider Demographics
NPI:1891001293
Name:DERMATOLOGY AND SKIN CANCER CENTER
Entity Type:Organization
Organization Name:DERMATOLOGY AND SKIN CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HUDGENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-704-7546
Mailing Address - Street 1:7450 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5119
Mailing Address - Country:US
Mailing Address - Phone:407-704-7546
Mailing Address - Fax:407-374-2992
Practice Address - Street 1:7450 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5119
Practice Address - Country:US
Practice Address - Phone:407-704-7546
Practice Address - Fax:407-374-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty