Healthcare Provider Details

I. General information

NPI: 1699007484
Provider Name (Legal Business Name): DERMASURGEONS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 PEMBROKE ROAD SUITE 100
MIRAMAR FL
33027
US

IV. Provider business mailing address

12600 PEMBROKE ROAD SUITE 100
MIRAMAR FL
33027
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-7681
  • Fax: 954-431-7682
Mailing address:
  • Phone: 954-431-7681
  • Fax: 954-431-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSE E MENDEZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 954-431-7681