Healthcare Provider Details

I. General information

NPI: 1336792811
Provider Name (Legal Business Name): CLEAR SKIN DERMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 N MCMULLEN BOOTH RD STE 424
CLEARWATER FL
33759-1339
US

IV. Provider business mailing address

2454 N MCMULLEN BOOTH RD STE 424
CLEARWATER FL
33759-1339
US

V. Phone/Fax

Practice location:
  • Phone: 727-248-0118
  • Fax: 727-286-9555
Mailing address:
  • Phone: 727-248-0118
  • Fax: 727-286-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: RACHEL EPSTEIN
Title or Position: PRESIDENT/OWNER
Credential: DO
Phone: 727-248-0118