Provider Demographics
NPI:1982179065
Name:ROXBURY DERMATOLOGY AND MULTISPECIALTY PRACTICE INC
Entity Type:Organization
Organization Name:ROXBURY DERMATOLOGY AND MULTISPECIALTY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMRON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:844-544-1617
Mailing Address - Street 1:450 N ROXBURY DR STE 410
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4231
Mailing Address - Country:US
Mailing Address - Phone:884-544-1617
Mailing Address - Fax:424-394-1627
Practice Address - Street 1:450 N ROXBURY DR STE 410
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4231
Practice Address - Country:US
Practice Address - Phone:884-544-1617
Practice Address - Fax:424-394-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty