Basic Information
| Provider Information | |||||||||
| NPI: | 1639329345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED DERMATOLOGY OF WEST BOCA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 BROKEN SOUND PKWY | ||||||||
| Address2: | STE 115 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612416676 | ||||||||
| FaxNumber: | 5619893665 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 BROKEN SOUND PKWY | ||||||||
| Address2: | STE 115 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334873507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612416676 | ||||||||
| FaxNumber: | 5619893665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2008 | ||||||||
| LastUpdateDate: | 09/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | PLOTKIN | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5612416676 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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.