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General NPI Number Information
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NPI Number | 1750826301
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ESTHETICA
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 718B LAKEVIEW RD
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City | CLEARWATER
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State | FL
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Zip | 33756-3439
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Country | US
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Telephone | 727-447-1229
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Fax | 727-446-0680
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Provider Business Mailing Address
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Address Line | 718B LAKEVIEW RD
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City | CLEARWATER
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State | FL
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Zip | 33756-3439
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Country | US
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Telephone | 727-447-1229
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Fax | 727-446-0680
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. PHYLLIS K MURPHY
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Credential | M.D.
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Telephone | 727-447-1229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | ME54484
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License Number State | FL
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