Healthcare Provider Details

I. General information

NPI: 1841559606
Provider Name (Legal Business Name): SKIN CANCER CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 MILITARY TRL SUITE 203
JUPITER FL
33458-4834
US

IV. Provider business mailing address

4601 MILITARY TRL SUITE 203
JUPITER FL
33458-4834
US

V. Phone/Fax

Practice location:
  • Phone: 561-775-6011
  • Fax: 561-775-6044
Mailing address:
  • Phone: 561-775-6011
  • Fax: 561-775-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME85020
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME85020
License Number StateFL

VIII. Authorized Official

Name: NOAH K WEISBERG
Title or Position: OWNER
Credential: M.D.
Phone: 561-775-6011