MEDICARE: DERMPATH PLUS INC

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
1	207ZD0900X	Dermatopathology (Pathology) Physician	MD022804	LA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME86922	FL
3	207ZD0900X	Dermatopathology (Pathology) Physician	M8087	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16802	OTHER	FL	BSBC

General Provider Information

NPI Number	:	1548271794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMPATH PLUS INC

Provider Business Mailing Address
First Line	:	829 GOLF ISLAND DR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2781
Country	:	US
Telephone Number	:	813-641-0130
Fax Number	:

Provider Business Practice Location Address
First Line	:	5946 FROND WAY
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2647
Country	:	US
Telephone Number	:	813-641-0466
Fax Number	:	813-641-0488

Authorized Official
Title or Position	:	MEDICAL DIRECTOR PRESIDENT
Name	:	DR. VALERIE Y RAY
Credential	:	MD
Telephone Number	:	813-760-5104

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	09/11/2025

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Directions to “DERMPATH PLUS INC ” Practice Location

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