Healthcare Provider Details

I. General information

NPI: 1215570445
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES OF THE PALM BEACHES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 DUCK SLOUGH BLVD STE 103
TRINITY FL
34655-5007
US

IV. Provider business mailing address

120A BUTLER ST STE A
WEST PALM BEACH FL
33407-6106
US

V. Phone/Fax

Practice location:
  • Phone: 727-807-9070
  • Fax: 727-807-5801
Mailing address:
  • Phone: 561-659-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOWARD GREEN
Title or Position: MANAGING PARTNER
Credential:
Phone: 561-659-1510