Healthcare Provider Details

I. General information

NPI: 1295842672
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF TALLAHASSEE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 RIGGINS RD
TALLAHASSEE FL
32308-5317
US

IV. Provider business mailing address

PO BOX 13859
TALLAHASSEE FL
32317-3859
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-4134
  • Fax: 850-402-9130
Mailing address:
  • Phone: 850-877-4134
  • Fax: 850-402-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN SCHAPER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 850-877-4134