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General NPI Number Information
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NPI Number | 1740472380
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Entity Type | Individual
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Provider Name | LAYNE MARC FIELDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 4400 HIGHWAY 20 E SUITE 410
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-897-4900
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Fax | 850-654-3320
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Provider Business Mailing Address
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Address Line | 4400 HIGHWAY 20 E SUITE 410
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-897-4900
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Fax | 850-654-3320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ME 119126
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | ME119126
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | ME119126
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License Number State | FL
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