=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629186523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DERMATOLOGY CONSULTANTS OF S FL PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 11/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 N UNIVERSITY DR SUITE K
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-5055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-752-2630
-----------------------------------------------------
Fax | 954-755-1865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 N UNIVERSITY DR SUITE K
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33065-5055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-752-2630
-----------------------------------------------------
Fax | 954-755-1865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. JEFFREY J KROLL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-752-2630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | MP36624
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------