Healthcare Provider Details

I. General information

NPI: 1649284563
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF TAMPA BAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MEMORIAL HWY
TAMPA FL
33615-4531
US

IV. Provider business mailing address

6001 MEMORIAL HWY
TAMPA FL
33615-4531
US

V. Phone/Fax

Practice location:
  • Phone: 813-884-1626
  • Fax: 813-886-0589
Mailing address:
  • Phone: 813-884-1626
  • Fax: 813-886-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN LOUIS MILLNS JR.
Title or Position: OWNER
Credential: M.D.
Phone: 813-884-1626