Provider Demographics
NPI:1649284563
Name:DERMATOLOGY ASSOCIATES OF TAMPA BAY, LLC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF TAMPA BAY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MILLNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:813-884-1626
Mailing Address - Street 1:6001 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4531
Mailing Address - Country:US
Mailing Address - Phone:813-884-1626
Mailing Address - Fax:813-886-0589
Practice Address - Street 1:6001 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4531
Practice Address - Country:US
Practice Address - Phone:813-884-1626
Practice Address - Fax:813-886-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0583Medicare PIN