Provider Demographics
NPI:1992851620
Name:NORTH FLORIDA DERMATOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:NORTH FLORIDA DERMATOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SCHIAVONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-354-4488
Mailing Address - Street 1:1541 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4124
Mailing Address - Country:US
Mailing Address - Phone:904-354-4488
Mailing Address - Fax:904-354-3331
Practice Address - Street 1:1541 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4124
Practice Address - Country:US
Practice Address - Phone:904-354-4488
Practice Address - Fax:904-354-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD52738Medicare UPIN
FL24179Medicare ID - Type Unspecified