Provider Demographics
NPI:1245647593
Name:DERMATOLOGY CENTRES, P.A.
Entity type:Organization
Organization Name:DERMATOLOGY CENTRES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-341-3344
Mailing Address - Street 1:216 S APOPKA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4845
Mailing Address - Country:US
Mailing Address - Phone:352-341-3344
Mailing Address - Fax:352-341-7700
Practice Address - Street 1:216 S APOPKA AVE STE A
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-341-3344
Practice Address - Fax:352-341-7700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DERMATOLOGY CENTRES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-18
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0006067207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3740013-00Medicaid
FL3740013-00Medicaid