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General NPI Number Information
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NPI Number | 1376687384
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF THE TREASURE COAST P A
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/08/2019
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Provider Practice Location Address
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Address Line | 809 SE OSCEOLA ST
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City | STUART
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State | FL
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Zip | 34994-2431
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Country | US
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Telephone | 772-219-0044
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Fax | 772-219-0709
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Provider Business Mailing Address
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Address Line | 809 SE OSCEOLA ST
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City | STUART
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State | FL
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Zip | 34994-2431
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Country | US
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Telephone | 772-219-0044
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Fax | 772-219-0709
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL KING
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Credential | M D
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Telephone | 772-219-0044
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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 | ME0069441
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License Number State | FL
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