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General NPI Number Information
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NPI Number | 1609990035
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Entity Type | Organization
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Legal Business Name | INTEGRATED DERMATOLOGY OF BOCA LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 30 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-395-6705
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Fax |
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Provider Business Mailing Address
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Address Line | 30 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-395-6705
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY QUEEN
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Credential |
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Telephone | 561-241-6676
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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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