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General NPI Number Information
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NPI Number | 1487065116
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Entity Type | Organization
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Legal Business Name | NORTH PALM DERMATOLOGY, LLC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 11380 PROSPERITY FARMS RD SUITE 213, BUILDING D
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3474
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Country | US
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Telephone | 561-694-5800
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Fax | 561-694-5700
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Provider Business Mailing Address
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Address Line | 11380 PROSPERITY FARMS RD SUITE 213, BUILDING D
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3474
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Country | US
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Telephone | 561-694-5800
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Fax | 561-694-5700
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Authorized Official
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Title or Position | PRESIDENT
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Name | HEATHER HOUCK
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Credential |
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Telephone | 561-694-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME117143
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License Number State | FL
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