Healthcare Provider Details

I. General information

NPI: 1336257450
Provider Name (Legal Business Name): SKIN CANCER CENTER OF CENTRAL FLORIDA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10973 SE 175TH PL STE 100
SUMMERFIELD FL
34491
US

IV. Provider business mailing address

10973 SE 175TH PL STE 100
SUMMERFIELD FL
34491-8983
US

V. Phone/Fax

Practice location:
  • Phone: 352-873-7788
  • Fax: 352-873-9397
Mailing address:
  • Phone: 352-259-6553
  • Fax: 352-873-9397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0062067
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY F BARBER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-259-6553