Provider Demographics
NPI:1811950371
Name:ASSOCIATES IN DERMATOLOGY M D P L
Entity type:Organization
Organization Name:ASSOCIATES IN DERMATOLOGY M D P L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-936-5425
Mailing Address - Street 1:8381 RIVERWALK PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8760
Mailing Address - Country:US
Mailing Address - Phone:239-936-5425
Mailing Address - Fax:239-936-5176
Practice Address - Street 1:8381 RIVERWALK PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8760
Practice Address - Country:US
Practice Address - Phone:239-936-5425
Practice Address - Fax:239-936-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77212OtherBC BS OF FLA
FLCF4641OtherRAIL ROAD MEDICARE
FL2071559OtherAETNA
FL77212Medicare ID - Type Unspecified