Provider Demographics
NPI:1740472380
Name:FIELDER, LAYNE MARC (MD)
Entity type:Individual
Prefix:DR
First Name:LAYNE
Middle Name:MARC
Last Name:FIELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4400 HIGHWAY 20 E
Mailing Address - Street 2:SUITE 410
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578
Mailing Address - Country:US
Mailing Address - Phone:850-897-4900
Mailing Address - Fax:850-654-3320
Practice Address - Street 1:4400 HIGHWAY 20 E
Practice Address - Street 2:SUITE 410
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578
Practice Address - Country:US
Practice Address - Phone:850-897-4900
Practice Address - Fax:850-654-3320
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2015-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 119126207N00000X
FLME119126207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology