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General NPI Number Information
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NPI Number | 1780659094
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Entity Type | Organization
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Legal Business Name | CLEARWATER DERMATOLOGY, P.A.
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 1122 DRUID RD E
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City | CLEARWATER
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State | FL
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Zip | 33756-4100
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Country | US
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Telephone | 727-461-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 DRUID RD E
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City | CLEARWATER
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State | FL
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Zip | 33756-4100
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Country | US
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Telephone | 727-461-2282
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER STEVEN GOLOMB
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Credential | MD
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Telephone | 727-461-2282
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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 | ME0021279
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License Number State | FL
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