Provider Demographics
NPI:1457806937
Name:DERMA LASER CENTER LLC
Entity Type:Organization
Organization Name:DERMA LASER CENTER LLC
Other - Org Name:HPE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-606-8831
Mailing Address - Street 1:701 W HALLANDALE BEACH BLVD # 104-105
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5327
Mailing Address - Country:US
Mailing Address - Phone:954-367-7073
Mailing Address - Fax:954-367-7075
Practice Address - Street 1:701 W HALLANDALE BEACH BLVD # 104-105
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5327
Practice Address - Country:US
Practice Address - Phone:954-367-7073
Practice Address - Fax:954-367-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty