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General NPI Number Information
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NPI Number | 1598257909
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Entity Type | Organization
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Legal Business Name | PARK NORTH DERMATOLOGY, PA
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 341 N MAITLAND AVE STE 210
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City | MAITLAND
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State | FL
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Zip | 32751-4771
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Country | US
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Telephone | 407-603-1748
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Fax | 586-580-4446
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Provider Business Mailing Address
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Address Line | 343 SAINT DUNSTAN WAY
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City | WINTER PARK
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State | FL
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Zip | 32792-4306
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Country | US
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Telephone | 407-399-7878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN THOMAS
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Credential | MD
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Telephone | 407-399-7878
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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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