Provider Demographics
NPI:1952716516
Name:MID-FLORIDA DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MID-FLORIDA DERMATOLOGY ASSOCIATES
Other - Org Name:HUNTER PHILLIPS DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:4072-999-7333
Mailing Address - Street 1:7652 ASHLEY PARK CT
Mailing Address - Street 2:SUITE 305
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 1:7652 ASHLEY PARK CT
Practice Address - Street 2:SUITE 305
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6199
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:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty