Provider Demographics
NPI:1336257450
Name:SKIN CANCER CENTER OF CENTRAL FLORIDA, P.A.
Entity Type:Organization
Organization Name:SKIN CANCER CENTER OF CENTRAL FLORIDA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-259-6553
Mailing Address - Street 1:10973 SE 175TH PL STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8983
Mailing Address - Country:US
Mailing Address - Phone:352-259-6553
Mailing Address - Fax:352-873-9397
Practice Address - Street 1:10973 SE 175TH PL STE 100
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491
Practice Address - Country:US
Practice Address - Phone:352-873-7788
Practice Address - Fax:352-873-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062067174400000X
207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372699100Medicaid
FLF36958Medicare UPIN
FL372699100Medicaid