Provider Demographics
NPI:1831425420
Name:DERMATOLOGY ASSOCIATES OF BAY COUNTY
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF BAY COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:HTL(ASCP)
Authorized Official - Phone:850-215-0953
Mailing Address - Street 1:2430 LISENBY AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3585
Mailing Address - Country:US
Mailing Address - Phone:850-215-0953
Mailing Address - Fax:850-215-0952
Practice Address - Street 1:2430 LISENBY AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-215-0953
Practice Address - Fax:850-215-0952
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DERMATOLOGY ASSOCIATES OF BAY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-02
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800025570207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty