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General NPI Number Information
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NPI Number | 1184734543
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF NORTHEAST FLORIDA, PA
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8 OFFICE PARK DR
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City | PALM COAST
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State | FL
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Zip | 32137-3808
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Country | US
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Telephone | 386-446-4466
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Fax | 386-446-6066
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Provider Business Mailing Address
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Address Line | 8 OFFICE PARK DR
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City | PALM COAST
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State | FL
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Zip | 32137-3808
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Country | US
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Telephone | 386-446-4466
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Fax | 386-446-6066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK S CHEIKEN
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Credential | D.O.
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Telephone | 386-446-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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