Healthcare Provider Details

I. General information

NPI: 1184865230
Provider Name (Legal Business Name): BIODERM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12320 73RD CT
LARGO FL
33773-3011
US

IV. Provider business mailing address

12320 73RD CT
LARGO FL
33773-3011
US

V. Phone/Fax

Practice location:
  • Phone: 727-507-7655
  • Fax: 727-507-7645
Mailing address:
  • Phone: 727-507-7655
  • Fax: 727-507-7645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. GARY L. DAMKOEHLER
Title or Position: CEO
Credential:
Phone: 727-507-7655