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General NPI Number Information
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NPI Number | 1558836445
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Entity Type | Organization
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Legal Business Name | DOCTA LLC
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 5200 S UNIVERSITY DR STE 102A
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City | DAVIE
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State | FL
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Zip | 33328-5316
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Country | US
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Telephone | 754-444-8503
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Fax | 561-907-4984
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Provider Business Mailing Address
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Address Line | 5200 S UNIVERSITY DR STE 102A
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City | DAVIE
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State | FL
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Zip | 33328-5316
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Country | US
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Telephone | 754-444-8503
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Fax | 561-907-4984
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Authorized Official
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Title or Position | OFFICE MANAGER/BILLING SPECIALIST
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Name | JESSICA HEGEDUS
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Credential |
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Telephone | 754-444-8503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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