Provider Demographics
NPI:1669147278
Name:MID-FLORIDA DERMATOLOGY ASSOCIATES
Entity type:Organization
Organization Name:MID-FLORIDA DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIR.
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-299-7333
Mailing Address - Street 1:7652 ASHLEY PARK CT STE 305
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6199
Mailing Address - Country:US
Mailing Address - Phone:407-299-7333
Mailing Address - Fax:407-293-2049
Practice Address - Street 1:1255 HIGHWAY 60 E STE 100
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4310
Practice Address - Country:US
Practice Address - Phone:407-299-7333
Practice Address - Fax:407-293-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty