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General NPI Number Information
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NPI Number | 1508983131
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CENTRES-TREASURE COAST P A
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 528 SE OSCEOLA ST 2ND FLOOR
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City | STUART
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State | FL
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Zip | 34994-2366
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Country | US
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Telephone | 772-287-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 5130 LINTON BLVD SUITE C4-5
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6596
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Country | US
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Telephone | 561-637-0222
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Fax | 561-637-8219
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANGELA MARIE WATT
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Credential |
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Telephone | 561-637-0222
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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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