Healthcare Provider Details

I. General information

NPI: 1538695168
Provider Name (Legal Business Name): DELRAY DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SE 6TH AVE SUITE 100
DELRAY BEACH FL
33483-5252
US

IV. Provider business mailing address

550 SE 6TH AVE STE 100
DELRAY BEACH FL
33483-5252
US

V. Phone/Fax

Practice location:
  • Phone: 561-440-8020
  • Fax: 561-440-8020
Mailing address:
  • Phone: 561-440-8020
  • Fax: 561-440-8222

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 Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCESCA LEWIS
Title or Position: OWNER
Credential: MD
Phone: 843-819-9907