Provider Demographics
NPI:1194914390
Name:DERMATOLOGY ASSOCIATES OF CENTRAL FLORIDA
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:YRASTORZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-686-2282
Mailing Address - Street 1:3670 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4105
Mailing Address - Country:US
Mailing Address - Phone:863-686-2282
Mailing Address - Fax:863-686-2370
Practice Address - Street 1:3670 INNOVATION DRIVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4105
Practice Address - Country:US
Practice Address - Phone:863-686-2282
Practice Address - Fax:863-686-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66580207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2053Medicare PIN
FLF87810Medicare UPIN