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General NPI Number Information
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NPI Number | 1891352225
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Entity Type | Organization
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Legal Business Name | LAS OLAS DERMATOLOGY INC
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 800 E BROWARD BLVD STE 507
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2034
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Country | US
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Telephone | 954-763-4331
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Fax | 954-763-4775
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Provider Business Mailing Address
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Address Line | 800 E BROWARD BLVD STE 507
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2034
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Country | US
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Telephone | 954-763-4331
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Fax | 954-763-4775
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Authorized Official
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Title or Position | OWNER
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Name | TONY NAKHLA
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Credential | DO
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Telephone | 954-763-4331
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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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