Healthcare Provider Details

I. General information

NPI: 1437444817
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF BAY COUNTY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 6TH ST
MARIANNA FL
32446-1930
US

IV. Provider business mailing address

1900 HARRISON AVE
PANAMA CITY FL
32405-4542
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-1668
  • Fax: 850-785-2123
Mailing address:
  • Phone: 850-769-1668
  • Fax: 850-785-2123

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

VIII. Authorized Official

Name: DR. ROBERT JOHN SIRAGUSA
Title or Position: PRESIDENT
Credential: MD
Phone: 850-769-1668