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General NPI Number Information
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NPI Number | 1871864264
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Entity Type | Organization
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Legal Business Name | SANDERS DERMATOLOGY AND SKIN CANCER CENTER,LLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 1155 35TH LN SUITE 202
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City | VERO BEACH
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State | FL
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Zip | 32960-6521
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Country | US
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Telephone | 772-778-7782
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Fax | 772-778-7879
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Provider Business Mailing Address
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Address Line | 1155 35TH LN SUITE 202
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City | VERO BEACH
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State | FL
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Zip | 32960-6521
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Country | US
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Telephone | 772-778-7782
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Fax | 772-778-7879
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JONATHAN SCOTT SANDERS
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Credential | M.D.
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Telephone | 772-778-7782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 87851
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 87851
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License Number State | FL
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