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General NPI Number Information
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NPI Number | 1881172906
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Entity Type | Organization
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Legal Business Name | PARKLAND DERMATOLOGY AND COSMETIC SURGERY
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 4360 N STATE ROAD 7
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3817
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Country | US
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Telephone | 754-999-3376
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Fax | 833-279-7072
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Provider Business Mailing Address
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Address Line | 4360 N STATE ROAD 7
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3817
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Country | US
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Telephone | 754-999-3376
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Fax | 833-279-7072
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Authorized Official
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Title or Position | OWNER
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Name | ALEXIS STEPHENS
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Credential | DO
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Telephone | 754-999-3376
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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 |
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License Number State |
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