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General NPI Number Information
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NPI Number | 1558579284
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Entity Type | Organization
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Legal Business Name | ADVANCED DERMATOLOGY & SKIN SURGERY SPECIALISTS PA
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 1000 GOODLETTE RD N SUITE 100
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City | NAPLES
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State | FL
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Zip | 34102-5474
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Country | US
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Telephone | 239-529-3376
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Fax | 239-643-0094
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Provider Business Mailing Address
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Address Line | 1000 GOODLETTE RD N SUITE 100
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City | NAPLES
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State | FL
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Zip | 34102-5474
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Country | US
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Telephone | 239-649-8384
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Fax | 239-643-0094
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LINDA DEE GLAESER
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Credential |
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Telephone | 239-529-3376
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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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