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General NPI Number Information
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NPI Number | 1487947008
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Entity Type | Organization
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Legal Business Name | CLEARLY DERM, LLC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 1760 N CONGRESS AVE SUITE 200
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8214
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Country | US
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Telephone | 561-739-9595
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Fax | 561-739-7546
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Provider Business Mailing Address
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Address Line | 7050 W PALMETTO PARK RD SUITE 30
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City | BOCA RATON
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State | FL
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Zip | 33433-3426
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Country | US
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Telephone | 561-353-3376
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Fax | 561-404-1170
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ANDREA COLTON
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Credential | MD
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Telephone | 561-299-3907
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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 | ME42065
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License Number State | FL
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