Basic Information
| Provider Information | |||||||||
| NPI: | 1447574694 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED DERMATOLOGY OF TAMARAC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 CLINT MOORE RD | ||||||||
| Address2: | 226 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613142000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7301 N UNIVERSITY DR | ||||||||
| Address2: | 102 | ||||||||
| City: | TAMARAC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333212919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547262000 | ||||||||
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| ProviderEnumerationDate: | 03/17/2010 | ||||||||
| LastUpdateDate: | 03/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialFirstName: | GERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5613142000 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.