Provider Demographics
NPI:1215570445
Name:DERMATOLOGY ASSOCIATES OF THE PALM BEACHES PLLC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF THE PALM BEACHES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-659-1510
Mailing Address - Street 1:120A BUTLER ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6106
Mailing Address - Country:US
Mailing Address - Phone:561-659-1510
Mailing Address - Fax:
Practice Address - Street 1:2160 DUCK SLOUGH BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5007
Practice Address - Country:US
Practice Address - Phone:727-807-9070
Practice Address - Fax:727-807-5801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DERMATOLOGY ASSOCIATES OF THE PALM BEACHES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty