Intracoastal Dermatology, Pllc

NPI 1194079988 - Dermatology - 207N00000X

NPI Details
NPI 1194079988
Enumeration Date 11/01/2012
Last Updated 11/01/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name KENDALL KENDALL
Position MANAGER
Phone (904) 655-5310
Fax
Practice Location
4776 HODGES BLVD STE 105
JACKSONVILLE FL, 32224-7218, US
Phone (904) 655-5310
Fax
Business Location
4776 HODGES BLVD STE 105
JACKSONVILLE FL, 32224-7218, US
Phone (904) 655-5310
Fax
Toxanomy
Taxonomy Code 207N00000X
License State Florida
License Number ME110325
Remove 1194079988 NPI Number
 

According to our database, Intracoastal Dermatology, Pllc NPI is 1194079988, taxonomy code is 207N00000X and license number is ME110325, license state is located at Florida. Intracoastal Dermatology, Pllc physically located at 4776 Hodges Blvd Ste 105, Jacksonville FL, 32224-7218. NPI Number 1033115704 has the healthcare provider type.

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1194079988 NPI number is provided on an as is basis without warranty of any kind. 1194079988 is maintained by the National Plan & Provider Enumeration System. The contents of Intracoastal Dermatology, Pllc are for informational purposes only.