=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184627754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA PRICE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2005
-----------------------------------------------------
Last Update Date | 11/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9060 SW 73RD CT
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-2961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-670-1111
-----------------------------------------------------
Fax | 305-670-1110
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9060 SW 73RD CT STE 502
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-2961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-670-1111
-----------------------------------------------------
Fax | 305-670-1110
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME039031
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------