Healthcare Provider Details

I. General information

NPI: 1336506260
Provider Name (Legal Business Name): ANDREW SPIROS DORIZAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BANYAN BLVD FL 2
WEST PALM BEACH FL
33401-4644
US

IV. Provider business mailing address

185 BANYAN BLVD FL 2
WEST PALM BEACH FL
33401-4644
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6704
  • Fax:
Mailing address:
  • Phone: 305-243-6704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME144623
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME14623
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME144623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: