Healthcare Provider Details

I. General information

NPI: 1508983131
Provider Name (Legal Business Name): DERMATOLOGY CENTRES-TREASURE COAST P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 SE OSCEOLA ST 2ND FLOOR
STUART FL
34994-2366
US

IV. Provider business mailing address

5130 LINTON BLVD SUITE C4-5
DELRAY BEACH FL
33484-6596
US

V. Phone/Fax

Practice location:
  • Phone: 772-287-3020
  • Fax:
Mailing address:
  • Phone: 561-637-0222
  • Fax: 561-637-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA MARIE WATT
Title or Position: PRESIDENT
Credential:
Phone: 561-637-0222