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General NPI Number Information
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NPI Number | 1215570445
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF THE PALM BEACHES PLLC
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 2160 DUCK SLOUGH BLVD STE 103
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City | TRINITY
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State | FL
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Zip | 34655-5007
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Country | US
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Telephone | 727-807-9070
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Fax | 727-807-5801
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Provider Business Mailing Address
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Address Line | 120A BUTLER ST STE A
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-6106
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Country | US
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Telephone | 561-659-1510
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | HOWARD GREEN
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Credential |
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Telephone | 561-659-1510
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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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