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General NPI Number Information
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NPI Number | 1255744793
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Entity Type | Organization
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Legal Business Name | ADVANTAGE DERMATOLOGY, PA
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 1514 NIRA ST
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8652
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Country | US
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Telephone | 904-387-4991
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Fax | 904-384-3613
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Provider Business Mailing Address
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Address Line | 1514 NIRA ST
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8652
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Country | US
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Telephone | 904-387-4991
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Fax | 904-384-3613
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Authorized Official
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Title or Position | CEO
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Name | DR. OLIVER ANGEL PEREZ
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Credential | MD
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Telephone | 904-387-4991
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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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