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General NPI Number Information
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NPI Number | 1790838175
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Entity Type | Organization
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Legal Business Name | WATERMAN DERMATOLOGY, PA
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 600 S PINE ISLAND RD SUITE 102
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City | PLANTATION
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State | FL
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Zip | 33324-3166
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Country | US
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Telephone | 954-473-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 600 S PINE ISLAND RD SUITE 102
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City | PLANTATION
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State | FL
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Zip | 33324-3166
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Country | US
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Telephone | 954-473-2078
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | GARY L WATERMAN
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Credential | DO
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Telephone | 954-473-2078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | OS4781
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License Number State | FL
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