MEDICARE: HIGHTOWER DERMATOLOGY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME 95249	FL

General Provider Information

NPI Number	:	1740620178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGHTOWER DERMATOLOGY SERVICES, LLC

Provider Business Mailing Address
First Line	:	957 E DEL WEBB BLVD
Second Line	:	SUITE 101
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6671
Country	:	US
Telephone Number	:	813-634-1484
Fax Number	:	813-435-2023

Provider Business Practice Location Address
First Line	:	957 E DEL WEBB BLVD
Second Line	:	SUITE 101
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6671
Country	:	US
Telephone Number	:	813-634-1484
Fax Number	:	813-435-2023

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KORTNEY D HIGHTOWER
Credential	:	MD
Telephone Number	:	813-634-1484

Provider Enumeration Date	:	06/29/2013
Last Update Date	:	10/11/2021

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