Provider Demographics
NPI:1942637772
Name:PREMIER DERMATOLOGY AND SKIN CANCER CENTER, PLLC
Entity Type:Organization
Organization Name:PREMIER DERMATOLOGY AND SKIN CANCER CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-215-0669
Mailing Address - Street 1:5935 WASHINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2642
Mailing Address - Country:US
Mailing Address - Phone:228-215-0669
Mailing Address - Fax:228-215-0669
Practice Address - Street 1:5935 WASHINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2642
Practice Address - Country:US
Practice Address - Phone:228-215-0669
Practice Address - Fax:228-215-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-13
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21095207N00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty