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General NPI Number Information
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NPI Number | 1831425420
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY ASSOCIATES OF BAY COUNTY
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 2430 LISENBY AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405
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Country | US
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Telephone | 850-215-0953
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Fax | 850-215-0952
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Provider Business Mailing Address
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Address Line | 2430 LISENBY AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-3585
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Country | US
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Telephone | 850-215-0953
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Fax | 850-215-0952
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Authorized Official
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Title or Position | LABORATORY MANAGER
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Name | MR. KENNETH WARREN ALEXANDER
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Credential | HTL(ASCP)
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Telephone | 850-215-0953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 800025570
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License Number State | FL
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