Provider Demographics
NPI:1740620178
Name:HIGHTOWER DERMATOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:HIGHTOWER DERMATOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KORTNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-634-1484
Mailing Address - Street 1:957 E DEL WEBB BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6671
Mailing Address - Country:US
Mailing Address - Phone:813-634-1484
Mailing Address - Fax:813-435-2023
Practice Address - Street 1:957 E DEL WEBB BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6671
Practice Address - Country:US
Practice Address - Phone:813-634-1484
Practice Address - Fax:813-435-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-29
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95249207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HL569AMedicare PIN