Provider Demographics
NPI:1922281005
Name:SOUTH FLORIDA DERMATOLOGY GROUP, INC.
Entity Type:Organization
Organization Name:SOUTH FLORIDA DERMATOLOGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VITOR
Authorized Official - Middle Name:F
Authorized Official - Last Name:WEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-445-2941
Mailing Address - Street 1:401 CORAL WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-445-2941
Mailing Address - Fax:305-445-7231
Practice Address - Street 1:401 CORAL WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-445-2941
Practice Address - Fax:305-445-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003390401Medicaid
FL003390400Medicaid