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General NPI Number Information
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NPI Number | 1093061582
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Entity Type | Organization
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Legal Business Name | FLORIDA DERMATOLOGY AND SKIN CANCER SPECIALISTS PL
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 870 77TH AVE N STE 1
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City | ST PETERSBURG
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State | FL
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Zip | 33702-5240
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Country | US
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Telephone | 727-821-3600
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Fax | 727-821-3611
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Provider Business Mailing Address
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Address Line | 870 77TH AVE N STE 1
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City | ST PETERSBURG
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State | FL
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Zip | 33702-5240
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Country | US
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Telephone | 727-821-3600
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Fax | 727-821-3611
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL A SCANNON
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Credential | MD
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Telephone | 813-877-4811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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