Healthcare Provider Details

I. General information

NPI: 1376714162
Provider Name (Legal Business Name): DERMATOLOGY ADVANCED CARE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 MAHAN DR
TALLAHASSEE FL
32308-5329
US

IV. Provider business mailing address

2433 MAHAN DR
TALLAHASSEE FL
32308-5329
US

V. Phone/Fax

Practice location:
  • Phone: 850-219-8811
  • Fax: 850-219-8883
Mailing address:
  • Phone: 850-219-8811
  • Fax: 850-219-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMASTER ID 8538
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS7111
License Number StateFL

VIII. Authorized Official

Name: DR. JAMES BREWSTER CALDWELL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 850-219-8811