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NPI Code Detail

MEDICARE: ADVANTAGE DERMATOLOGY, PA

MEDICARE: ADVANTAGE DERMATOLOGY, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255744793
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANTAGE DERMATOLOGY, PA
Provider Business Mailing Address
First Line : 1514 NIRA ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8652
Country : US
Telephone Number : 904-387-4991
Fax Number : 904-384-3613
Provider Business Practice Location Address
First Line : 1514 NIRA ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8652
Country : US
Telephone Number : 904-387-4991
Fax Number : 904-384-3613
Authorized Official
Title or Position : CEO
Name : DR. OLIVER ANGEL PEREZ
Credential : MD
Telephone Number : 904-387-4991
Provider Enumeration Date : 06/03/2014
Last Update Date : 06/19/2024

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1720520687 — CHRISTOPHER JAMES KALLINGER PA-C, MMS
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1821531427 — MELISSA GAGLIARDI ARNP
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1518402767 — JACQUELYN O'DONNELL PA-C
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Practice Fax: 904-384-3613

Directions to “ADVANTAGE DERMATOLOGY, PA ” Practice Location

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